Provider Demographics
NPI:1184939621
Name:BAKER, MEGAN JANEE (DMD)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:JANEE
Last Name:BAKER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1429 CENTER DR STE 104
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-7993
Mailing Address - Country:US
Mailing Address - Phone:541-500-6001
Mailing Address - Fax:
Practice Address - Street 1:1429 CENTER DR STE 104
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-7993
Practice Address - Country:US
Practice Address - Phone:541-500-6001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD94941223X0400X
CA1036971223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics