Provider Demographics
NPI:1023292315
Name:BAKER, JAMES WENDELL (DDS)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:WENDELL
Last Name:BAKER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 MAIN
Mailing Address - Street 2:
Mailing Address - City:GOODLAND
Mailing Address - State:KS
Mailing Address - Zip Code:17735
Mailing Address - Country:US
Mailing Address - Phone:785-890-2562
Mailing Address - Fax:
Practice Address - Street 1:1009 MAIN
Practice Address - Street 2:
Practice Address - City:GOODLAND
Practice Address - State:KS
Practice Address - Zip Code:17735
Practice Address - Country:US
Practice Address - Phone:785-890-2562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS56381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice