MEDICARE: DAVID B BAPTIST DDS PC

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	19015601	IL

General Provider Information

NPI Number	:	1841372208
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID B BAPTIST DDS PC

Provider Business Mailing Address
First Line	:	3838 W 111TH ST
Second Line	:	SUITE 111
City	:	CHICAGO
State	:	IL
Zip	:	60655-4095
Country	:	US
Telephone Number	:	773-233-1249
Fax Number	:	773-233-6771

Provider Business Practice Location Address
First Line	:	3838 W 111TH ST
Second Line	:	SUITE 111
City	:	CHICAGO
State	:	IL
Zip	:	60655-4095
Country	:	US
Telephone Number	:	773-233-1249
Fax Number	:	773-233-6771

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID B BAPTIST
Credential	:
Telephone Number	:	773-233-1249

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	08/22/2020

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