Provider Demographics
NPI:1649370461
Name:BAKER, KENNETH W (DDS)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:W
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 1:5000 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2832
Mailing Address - Country:US
Mailing Address - Phone:956-686-2052
Mailing Address - Fax:956-682-1749
Practice Address - Street 1:5000 N 10TH ST
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2832
Practice Address - Country:US
Practice Address - Phone:956-686-2052
Practice Address - Fax:956-682-1749
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX124051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice