Healthcare Provider Details

I. General information

NPI: 1720085905
Provider Name (Legal Business Name): WESLEY BAKER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/04/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 UNION ST
BENNINGTON VT
05201-2498
US

IV. Provider business mailing address

231 UNION ST PO BOX 965
BENNINGTON VT
05201-2498
US

V. Phone/Fax

Practice location:
  • Phone: 802-447-1648
  • Fax: 802-447-2628
Mailing address:
  • Phone: 802-447-1648
  • Fax: 802-447-2628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number016-0000745
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: