Healthcare Provider Details

I. General information

NPI: 1780769836
Provider Name (Legal Business Name): BRYAN S BAKER DDS AND STEPHEN A BAKER DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 11/13/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 E KING ST STE 9
KINGS MOUNTAIN NC
28086-3285
US

IV. Provider business mailing address

703 E KING ST STE 9
KINGS MOUNTAIN NC
28086-3285
US

V. Phone/Fax

Practice location:
  • Phone: 704-739-4461
  • Fax: 704-739-8286
Mailing address:
  • Phone: 704-739-4461
  • Fax: 704-739-8286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5999
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. BRYAN SCOTT BAKER
Title or Position: DENTIST
Credential: DDS
Phone: 704-739-4461