Healthcare Provider Details

I. General information

NPI: 1821136888
Provider Name (Legal Business Name): TAMMY MARIE BAKER D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

547 SPINNING RD
DAYTON OH
45431-2157
US

IV. Provider business mailing address

3954 CARMELA CT E
BELLBROOK OH
45305-1373
US

V. Phone/Fax

Practice location:
  • Phone: 937-252-1463
  • Fax:
Mailing address:
  • Phone: 937-848-9286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number20943
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: