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General NPI Number Information
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NPI Number | 1154443182
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Entity Type | Organization
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Legal Business Name | L. BRADLEY BAKER, DMD, PSC
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1300 SOUTHTOWN BLVD
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City | OWENSBORO
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State | KY
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Zip | 42301-7481
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Country | US
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Telephone | 270-684-7433
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Fax | 270-685-4114
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Provider Business Mailing Address
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Address Line | 1300 SOUTHTOWN BLVD
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City | OWENSBORO
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State | KY
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Zip | 42301-7481
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Country | US
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Telephone | 270-684-7433
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Fax | 270-685-4114
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. LAWRENCE BRADLEY BAKER
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Credential | DMD
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Telephone | 270-684-7433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | KY6187
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License Number State | KY
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