Healthcare Provider Details

I. General information

NPI: 1700947827
Provider Name (Legal Business Name): DORSEY W.BAKER D.D.S. PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 05/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18275 N 59TH AVE STE 150
GLENDALE AZ
85308-1260
US

IV. Provider business mailing address

18275 N 59TH AVE STE 150
GLENDALE AZ
85308-1260
US

V. Phone/Fax

Practice location:
  • Phone: 602-942-0623
  • Fax: 602-942-2409
Mailing address:
  • Phone: 602-942-0623
  • Fax: 602-942-2409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number3760
License Number StateAZ

VIII. Authorized Official

Name: DR. DORSEY W BAKER
Title or Position: MEMBER
Credential: D.D.S.
Phone: 602-942-0623