Healthcare Provider Details

I. General information

NPI: 1477702934
Provider Name (Legal Business Name): CAPPIE BAKER, DDS, MS, A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 03/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20930 BONITA ST SUITE X
CARSON CA
90746-3680
US

IV. Provider business mailing address

20930 BONITA ST SUITE X
CARSON CA
90746-3680
US

V. Phone/Fax

Practice location:
  • Phone: 310-523-2161
  • Fax:
Mailing address:
  • Phone: 310-523-2161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberB32531
License Number StateCA

VIII. Authorized Official

Name: DR. CAPPIE BAKER
Title or Position: PRESIDENT/ORTHODONTIST
Credential: DDS, MS
Phone: 310-523-2161