MEDICARE: DR. RICHARD J BAKER D.D.S.

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
1	1223G0001X	General Practice Dentistry	11524	MI

General Provider Information

NPI Number	:	1558317974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD J BAKER D.D.S.

Provider Business Mailing Address
First Line	:	3485 AIRPORT RD
Second Line	:
City	:	WATERFORD
State	:	MI
Zip	:	48329-3017
Country	:	US
Telephone Number	:	248-623-7722
Fax Number	:	248-623-9816

Provider Business Practice Location Address
First Line	:	3485 AIRPORT RD
Second Line	:
City	:	WATERFORD
State	:	MI
Zip	:	48329-3017
Country	:	US
Telephone Number	:	248-623-7722
Fax Number	:	248-623-9816

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	07/08/2007

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