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General NPI Number Information
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NPI Number | 1063687135
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Entity Type | Organization
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Legal Business Name | LARRY S. BAKER, D.D.S., INC.
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Dates
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Enumeration Date | 04/29/2008
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Last Update Date | 04/29/2008
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Provider Practice Location Address
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Address Line | 2616 W I 44 SERVICE RD
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-3720
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Country | US
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Telephone | 405-943-3575
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Fax | 405-943-3583
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Provider Business Mailing Address
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Address Line | 2616 W I 44 SERVICE RD
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-3720
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Country | US
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Telephone | 405-943-3575
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Fax | 405-943-3583
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MARY H. LUNDY
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Credential |
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Telephone | 405-943-3575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 4399
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License Number State | OK
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