MEDICARE: BAKER, DEST, BAKER, DDS, PLLC

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	5283	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578720967
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAKER, DEST, BAKER, DDS, PLLC

Provider Business Mailing Address
First Line	:	8305 UNIVERSITY EXEC PARK DR
Second Line	:	SUITE 300
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-1361
Country	:	US
Telephone Number	:	704-547-1279
Fax Number	:	704-547-8383

Provider Business Practice Location Address
First Line	:	107 E MOUNTAIN ST
Second Line	:
City	:	KINGS MOUNTAIN
State	:	NC
Zip	:	28086-3442
Country	:	US
Telephone Number	:	704-739-4473
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED AGENT/MEMBER
Name	:	DR. RICHARD F DEST
Credential	:	DDS
Telephone Number	:	704-547-1279

Provider Enumeration Date	:	05/22/2008
Last Update Date	:	05/28/2008

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