Healthcare Provider Details

I. General information

NPI: 1598268849
Provider Name (Legal Business Name): BAKER PEDIATRIC DENTAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2018
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25906 NEWPORT RD STE 101
MENIFEE CA
92584-9130
US

IV. Provider business mailing address

25906 NEWPORT RD STE 101
MENIFEE CA
92584-9130
US

V. Phone/Fax

Practice location:
  • Phone: 951-672-1666
  • Fax: 855-895-3627
Mailing address:
  • Phone: 951-672-1666
  • Fax: 855-895-3627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. RYAN B BAKER
Title or Position: OWNER
Credential: DMD
Phone: 858-405-8434