Provider Demographics
NPI:1720085905
Name:BAKER, WESLEY (DMD)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:
Last Name:BAKER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 UNION ST
Mailing Address - Street 2:PO BOX 965
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-2498
Mailing Address - Country:US
Mailing Address - Phone:802-447-1648
Mailing Address - Fax:802-447-2628
Practice Address - Street 1:231 UNION ST
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-2498
Practice Address - Country:US
Practice Address - Phone:802-447-1648
Practice Address - Fax:802-447-2628
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016-00007451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0002349Medicaid