Provider Demographics
NPI:1295877348
Name:BAKER, MARIANNA SERENA (DDS)
Entity type:Individual
Prefix:DR
First Name:MARIANNA
Middle Name:SERENA
Last Name:BAKER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 MONROE ST
Mailing Address - Street 2:BLDG.D
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-2263
Mailing Address - Country:US
Mailing Address - Phone:419-824-3456
Mailing Address - Fax:419-824-3456
Practice Address - Street 1:5800 MONROE ST
Practice Address - Street 2:BLDG.D
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2263
Practice Address - Country:US
Practice Address - Phone:419-824-3456
Practice Address - Fax:419-824-3456
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH13834122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist