Healthcare Provider Details

I. General information

NPI: 1437648276
Provider Name (Legal Business Name): KAYLA RENEE BAKER RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2018
Last Update Date: 12/08/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 E RIVER RD
BELEN NM
87002-7429
US

IV. Provider business mailing address

1934 BRYN MAWR DR NE
ALBUQUERQUE NM
87106-1711
US

V. Phone/Fax

Practice location:
  • Phone: 505-864-6969
  • Fax:
Mailing address:
  • Phone: 505-977-9219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH4326
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: