Healthcare Provider Details

I. General information

NPI: 1235320417
Provider Name (Legal Business Name): DAVID SCOTT BAKER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 02/10/2021
Certification Date: 01/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

591 S HORSEBARN RD STE 100
ROGERS AR
72758-8710
US

IV. Provider business mailing address

591 S HORSEBARN RD STE 100
ROGERS AR
72758-8710
US

V. Phone/Fax

Practice location:
  • Phone: 479-636-3779
  • Fax: 479-636-0800
Mailing address:
  • Phone: 479-636-3979
  • Fax: 479-636-0800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number3615
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: