Healthcare Provider Details

I. General information

NPI: 1871070953
Provider Name (Legal Business Name): ZACHARY WAYNE BAKER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2018
Last Update Date: 07/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 MONUMENT DR
MILLBROOK AL
36054-1849
US

IV. Provider business mailing address

114 E POPLAR ST
PRATTVILLE AL
36066-3639
US

V. Phone/Fax

Practice location:
  • Phone: 334-285-3797
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6560
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: