MEDICARE: JOHN PATRICK 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	0401-006109	VA

General Provider Information

NPI Number	:	1831283563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN PATRICK BAKER D.D.S.

Provider Business Mailing Address
First Line	:	1170 LEXAN AVE
Second Line	:	SUITE 187
City	:	NORFOLK
State	:	VA
Zip	:	23508-1237
Country	:	US
Telephone Number	:	757-440-1360
Fax Number	:	757-440-1361

Provider Business Practice Location Address
First Line	:	1170 LEXAN AVE
Second Line	:	SUITE 187
City	:	NORFOLK
State	:	VA
Zip	:	23508-1237
Country	:	US
Telephone Number	:	757-440-1360
Fax Number	:	757-440-1361

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	07/08/2007

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