Healthcare Provider Details

I. General information

NPI: 1457456956
Provider Name (Legal Business Name): SUSAN JEAN BAKER DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 ST MARY STREET
KNOXVILLE TN
37917
US

IV. Provider business mailing address

1705 ST MARY STREET
KNOXVILLE TN
37917
US

V. Phone/Fax

Practice location:
  • Phone: 865-370-2125
  • Fax: 865-370-2160
Mailing address:
  • Phone: 865-370-2125
  • Fax: 865-370-2160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number11835
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: