Provider Demographics
NPI:1841279528
Name:BAKER, CRAIG JARED (DMD)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:JARED
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 1:13501 ICOT BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33760-3729
Mailing Address - Country:US
Mailing Address - Phone:727-531-4462
Mailing Address - Fax:727-210-1754
Practice Address - Street 1:13501 ICOT BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-3729
Practice Address - Country:US
Practice Address - Phone:727-531-4462
Practice Address - Fax:727-210-1754
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN171631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL076027700Medicaid