Provider Demographics
NPI:1780769836
Name:BRYAN S BAKER DDS AND STEPHEN A BAKER DDS PA
Entity type:Organization
Organization Name:BRYAN S BAKER DDS AND STEPHEN A BAKER DDS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-739-4461
Mailing Address - Street 1:703 E KING ST STE 9
Mailing Address - Street 2:
Mailing Address - City:KINGS MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28086-3285
Mailing Address - Country:US
Mailing Address - Phone:704-739-4461
Mailing Address - Fax:704-739-8286
Practice Address - Street 1:703 E KING ST STE 9
Practice Address - Street 2:
Practice Address - City:KINGS MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28086-3285
Practice Address - Country:US
Practice Address - Phone:704-739-4461
Practice Address - Fax:704-739-8286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
NC59991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty