Healthcare Provider Details

I. General information

NPI: 1174704712
Provider Name (Legal Business Name): LARRY L BAKER, MD, DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2007
Last Update Date: 11/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W 9TH ST
HASTINGS NE
68901-3908
US

IV. Provider business mailing address

PO BOX 947
HASTINGS NE
68902-0947
US

V. Phone/Fax

Practice location:
  • Phone: 402-463-3088
  • Fax: 402-463-3099
Mailing address:
  • Phone: 402-463-3088
  • Fax: 402-463-3099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number22775
License Number StateNE

VIII. Authorized Official

Name: DR. LARRY L BAKER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 402-463-3088