Provider Demographics
NPI:1295148880
Name:BAKER, ANDREW MARK (DDS MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:MARK
Last Name:BAKER
Suffix:
Gender:M
Credentials:DDS MD
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Mailing Address - Street 1:4500 CASCADE RD SE STE 208
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3665
Mailing Address - Country:US
Mailing Address - Phone:616-977-5000
Mailing Address - Fax:616-977-0020
Practice Address - Street 1:4500 CASCADE RD SE STE 208
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3665
Practice Address - Country:US
Practice Address - Phone:616-977-5000
Practice Address - Fax:616-977-0020
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-11
Last Update Date:2023-10-02
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Provider Licenses
StateLicense IDTaxonomies
MI2901601271204E00000X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty