Healthcare Provider Details

I. General information

NPI: 1043240344
Provider Name (Legal Business Name): IRENA M BAKER D. D. S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4704 RAINIER AVE S
SEATTLE WA
98118-1658
US

IV. Provider business mailing address

4704 RAINIER AVE S
SEATTLE WA
98118-1658
US

V. Phone/Fax

Practice location:
  • Phone: 206-721-5500
  • Fax: 206-721-0684
Mailing address:
  • Phone: 206-721-5500
  • Fax: 206-721-0684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDE00006659
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: