Provider Demographics
NPI:1881981645
Name:BAKER, JUSTIN C (DDS)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:C
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 1:413 TRANQUILLO DR
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77905-0663
Mailing Address - Country:US
Mailing Address - Phone:361-550-1538
Mailing Address - Fax:
Practice Address - Street 1:235 GRAND AVE
Practice Address - Street 2:
Practice Address - City:BACLIFF
Practice Address - State:TX
Practice Address - Zip Code:77518-1609
Practice Address - Country:US
Practice Address - Phone:281-559-1531
Practice Address - Fax:281-559-1532
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX271481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice