Provider Demographics
NPI:1457030405
Name:BAKER, ALYSSA (DMD)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
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 1:5001 PROSPECT AVE # 3B
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-3790
Mailing Address - Country:US
Mailing Address - Phone:847-345-6254
Mailing Address - Fax:
Practice Address - Street 1:111 N WABASH AVE STE 1921
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-2970
Practice Address - Country:US
Practice Address - Phone:312-332-4424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0344361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice