Healthcare Provider Details

I. General information

NPI: 1467484774
Provider Name (Legal Business Name): DAVID P BAKER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 03/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 LJK WAY
STEVENSVILLE MT
59870-6562
US

IV. Provider business mailing address

120 LJK WAY
STEVENSVILLE MT
59870-6562
US

V. Phone/Fax

Practice location:
  • Phone: 406-777-5070
  • Fax: 406-777-4266
Mailing address:
  • Phone: 406-777-5070
  • Fax: 406-777-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1592
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: