Provider Demographics
NPI:1467484774
Name:BAKER, DAVID P (DDS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:P
Last Name:BAKER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 LJK WAY
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MT
Mailing Address - Zip Code:59870-6562
Mailing Address - Country:US
Mailing Address - Phone:406-777-5070
Mailing Address - Fax:406-777-4266
Practice Address - Street 1:120 LJK WAY
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MT
Practice Address - Zip Code:59870-6562
Practice Address - Country:US
Practice Address - Phone:406-777-5070
Practice Address - Fax:406-777-4266
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT15921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
81-0394986OtherFEIN