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General NPI Number Information
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NPI Number | 1518172428
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Entity Type | Organization
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Legal Business Name | MARY C BAKER DDS PC
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 06/19/2008
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Provider Practice Location Address
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Address Line | 1101 S HUNTINGTON ST STE 4
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City | SYRACUSE
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State | IN
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Zip | 46567-1981
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Country | US
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Telephone | 524-457-5771
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Fax | 524-457-5771
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Provider Business Mailing Address
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Address Line | 1101 S HUNTINGTON ST STE 4
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City | SYRACUSE
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State | IN
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Zip | 46567-1981
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Country | US
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Telephone | 524-457-5771
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Fax | 524-457-5771
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MARY C BAKER
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Credential | DDS
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Telephone | 524-457-5771
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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 | 12010687
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License Number State | IN
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