Healthcare Provider Details

I. General information

NPI: 1922899103
Provider Name (Legal Business Name): NATHAN BAKER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2025
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4049 E WILLIAMS FIELD RD STE 109
GILBERT AZ
85295-3217
US

IV. Provider business mailing address

3736 E JUNIPER CIR
MESA AZ
85205-3826
US

V. Phone/Fax

Practice location:
  • Phone: 480-840-3600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD012781
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: