Healthcare Provider Details

I. General information

NPI: 1528212115
Provider Name (Legal Business Name): DAVID MICHAEL BAKER D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2008
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1692B HOSPITAL DR STE 201B
SANTA FE NM
87505-4825
US

IV. Provider business mailing address

14 BLUE JAY DR
SANTA FE NM
87506-8509
US

V. Phone/Fax

Practice location:
  • Phone: 505-988-1187
  • Fax: 505-988-2186
Mailing address:
  • Phone: 617-218-7265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number22189
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDD3284
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: