Healthcare Provider Details

I. General information

NPI: 1164150637
Provider Name (Legal Business Name): MIA BAKER DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2022
Last Update Date: 11/23/2025
Certification Date: 11/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 UPDIKE AVE
NORTH KINGSTOWN RI
02852-5728
US

IV. Provider business mailing address

29 UPDIKE AVE
NORTH KINGSTOWN RI
02852-5728
US

V. Phone/Fax

Practice location:
  • Phone: 401-295-1992
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN03624
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: