MEDICARE: DR. LIONEL 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	122300000X	Dentist	10105	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	819740	OTHER	GA	COMMERCIAL INSURANCE

General Provider Information

NPI Number	:	1770671463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LIONEL BAKER D.D.S.

Provider Business Mailing Address
First Line	:	2019 7TH AVE
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-8913
Country	:	US
Telephone Number	:	706-324-7249
Fax Number	:	706-324-7290

Provider Business Practice Location Address
First Line	:	2019 7TH AVE
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-8913
Country	:	US
Telephone Number	:	706-324-7249
Fax Number	:	706-324-7290

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

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	07/09/2007

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