Healthcare Provider Details

I. General information

NPI: 1205931409
Provider Name (Legal Business Name): RAYMOND C. BAKER JR DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1922 THOMSON DRIVE
LYNCHBURG VA
24501
US

IV. Provider business mailing address

1922 THOMSON DRIVE
LYNCHBURG VA
24501
US

V. Phone/Fax

Practice location:
  • Phone: 434-845-1121
  • Fax: 434-845-1096
Mailing address:
  • Phone: 434-845-1121
  • Fax: 434-845-1096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401004767
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number0438000105
License Number StateVA

VIII. Authorized Official

Name: RAYMOND C BAKER JR.
Title or Position: OWNER
Credential: DDS
Phone: 434-845-1121