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NPI Code Detail

MEDICARE: DR. JACOB L BAKER DMD

MEDICARE: DR. JACOB L BAKER DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry5400AL

General Provider Information

NPI Number : 1215042767
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JACOB L BAKER DMD
Provider Business Mailing Address
First Line : 2409 SPORTSMAN DR
Second Line :
City : PHENIX CITY
State : AL
Zip : 36867-5402
Country : US
Telephone Number : 334-297-5890
Fax Number : 334-298-2725
Provider Business Practice Location Address
First Line : 2409 SPORTSMAN DR
Second Line :
City : PHENIX CITY
State : AL
Zip : 36867-5402
Country : US
Telephone Number : 334-297-5890
Fax Number : 334-298-2725
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2006
Last Update Date : 07/08/2007

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