Healthcare Provider Details

I. General information

NPI: 1851788053
Provider Name (Legal Business Name): SUZANNE DAVIS BAKER DDS, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUZANNE LOUISE DAVIS D.D.S.

II. Dates (important events)

Enumeration Date: 04/25/2015
Last Update Date: 07/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 GLENWOOD AVE SUITE 110
RALEIGH NC
27603
US

IV. Provider business mailing address

2800 WAKEFIELD PINES DRIVE SUITE 110
RALEIGH NC
27614
US

V. Phone/Fax

Practice location:
  • Phone: 919-570-0180
  • Fax: 919-570-0280
Mailing address:
  • Phone: 919-570-0180
  • Fax: 919-570-0280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number10053
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: