Provider Demographics
NPI:1023098993
Name:BAKER, WILLIAM R IV (DMD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:R
Last Name:BAKER
Suffix:IV
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1903 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-4599
Mailing Address - Country:US
Mailing Address - Phone:218-829-1728
Mailing Address - Fax:218-829-1729
Practice Address - Street 1:1903 S 6TH ST
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-4599
Practice Address - Country:US
Practice Address - Phone:218-829-1728
Practice Address - Fax:218-829-1729
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND104671223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN15169OtherDORAL DENTAL
MN86-00410OtherMEDICA MNCARE-DETROIT LK
MN86-24260OtherMEDICA MNCARE-BEMIDJI
MN150057OtherUCARE
MN86-24258OtherMEDICA MNCARE-BRAINERD
MN86-24259OtherMEDICA MNCARE-LITTLE FALL
MN190006049OtherRAILROAD MEDICARE
MN537022100Medicaid
MN537022100Medicaid
MN150057OtherUCARE