Healthcare Provider Details

I. General information

NPI: 1245075852
Provider Name (Legal Business Name): SHALEY ASHTON BAKER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2024
Last Update Date: 06/26/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 S WOODBINE RD
SAINT JOSEPH MO
64506-3468
US

IV. Provider business mailing address

420 S WOODBINE RD
SAINT JOSEPH MO
64506-3468
US

V. Phone/Fax

Practice location:
  • Phone: 816-232-8788
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2023024524
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: