Provider Demographics
NPI:1932324563
Name:BAKER, CHARLES FERDINAND (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:FERDINAND
Last Name:BAKER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 W PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45506-2206
Mailing Address - Country:US
Mailing Address - Phone:937-322-9652
Mailing Address - Fax:937-322-5227
Practice Address - Street 1:144 W PLEASANT ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45506-2206
Practice Address - Country:US
Practice Address - Phone:937-322-9652
Practice Address - Fax:937-322-5227
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30019373122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0865578Medicaid