Healthcare Provider Details

I. General information

NPI: 1699845453
Provider Name (Legal Business Name): MOOREAN ANN BAKER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1341 PENNSYLVANIA AVE SE
WASHINGTON DC
20003
US

IV. Provider business mailing address

1341 PENNSYLVANIA AVE SE
WASHINGTON DC
20003
US

V. Phone/Fax

Practice location:
  • Phone: 202-547-6453
  • Fax: 202-547-4575
Mailing address:
  • Phone: 202-547-6453
  • Fax: 202-547-4575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDEN3930
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number08010
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: