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General NPI Number Information
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NPI Number | 1144583329
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Entity Type | Individual
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Provider Name | RAQUEL BAXTER D.D.S
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Gender | Female
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Dates
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Enumeration Date | 06/21/2012
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Last Update Date | 12/06/2022
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Provider Practice Location Address
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Address Line | 2301 N 36TH ST STE 102
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City | BOISE
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State | ID
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Zip | 83703
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Country | US
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Telephone | 208-336-8801
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Fax | 208-466-5359
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Provider Business Mailing Address
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Address Line | 7703 FLOYD CURL DR # 7914
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City | SAN ANTONIO
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State | TX
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Zip | 78229-3900
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Country | US
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Telephone | 248-762-8677
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 29914
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D-5022
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License Number State | ID
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