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General NPI Number Information
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NPI Number | 1548347693
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Entity Type | Individual
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Provider Name | MARTIN HATHORN BAKER JR. DDS MS
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Gender | Male
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6504 HIGHWAY 98 STE G
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City | HATTIESBURG
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State | MS
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Zip | 39402
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Country | US
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Telephone | 601-544-2222
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 15609
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City | HATTIESBURG
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State | MS
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Zip | 39404-5609
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Country | US
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Telephone | 601-544-2222
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | OR10485
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License Number State | MS
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