Provider Demographics
NPI:1336369974
Name:BAKER, DANIELLE MICHELLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:MICHELLE
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 1:336 ARTIST LAKE DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLE ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:11953-2329
Mailing Address - Country:US
Mailing Address - Phone:631-926-9402
Mailing Address - Fax:
Practice Address - Street 1:110 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11955-1407
Practice Address - Country:US
Practice Address - Phone:631-878-4488
Practice Address - Fax:631-878-7330
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0513031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice