Healthcare Provider Details

I. General information

NPI: 1861328825
Provider Name (Legal Business Name): BAKER RESTORATIVE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

546 S 5TH ST
MACCLENNY FL
32063-2602
US

IV. Provider business mailing address

2754 COLLEGE ST
JACKSONVILLE FL
32205-7412
US

V. Phone/Fax

Practice location:
  • Phone: 904-259-5007
  • Fax:
Mailing address:
  • Phone: 336-414-3623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. CAMDEN SMITH
Title or Position: OWNER
Credential: DDS
Phone: 336-414-3623