Healthcare Provider Details

I. General information

NPI: 1952932055
Provider Name (Legal Business Name): RYAN B BAKER DMD APDC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2020
Last Update Date: 01/28/2020
Certification Date: 01/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27180 NEWPORT RD STE 3
MENIFEE CA
92584-7389
US

IV. Provider business mailing address

14591 NEWPORT AVE STE 108
TUSTIN CA
92780-6026
US

V. Phone/Fax

Practice location:
  • Phone: 951-672-1666
  • Fax:
Mailing address:
  • Phone: 949-771-7234
  • Fax: 949-771-7566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: CATHY LOYOLA
Title or Position: MANAGER
Credential:
Phone: 949-771-7381