Healthcare Provider Details

I. General information

NPI: 1396502050
Provider Name (Legal Business Name): BAKER DENTAL STUDIO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2024
Last Update Date: 04/21/2024
Certification Date: 04/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 E PARIS AVE SE STE 210
GRAND RAPIDS MI
49546-6113
US

IV. Provider business mailing address

2060 E PARIS AVE SE STE 210
GRAND RAPIDS MI
49546-6113
US

V. Phone/Fax

Practice location:
  • Phone: 440-836-2188
  • Fax:
Mailing address:
  • Phone: 616-949-7290
  • 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. NITHYA BAKER
Title or Position: OWNER DOCTOR
Credential: DDS
Phone: 616-949-7290