=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205931409
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RAYMOND C. BAKER JR DDS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1922 THOMSON DRIVE
-----------------------------------------------------
City | LYNCHBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-845-1121
-----------------------------------------------------
Fax | 434-845-1096
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1922 THOMSON DRIVE
-----------------------------------------------------
City | LYNCHBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-845-1121
-----------------------------------------------------
Fax | 434-845-1096
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | RAYMOND C BAKER JR.
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 434-845-1121
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 0401004767
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 204E00000X
-----------------------------------------------------
Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
-----------------------------------------------------
License Number | 0438000105
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------