=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598268849
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BAKER PEDIATRIC DENTAL CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2018
-----------------------------------------------------
Last Update Date | 11/27/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25906 NEWPORT RD STE 101
-----------------------------------------------------
City | MENIFEE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92584-9130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-672-1666
-----------------------------------------------------
Fax | 855-895-3627
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25906 NEWPORT RD STE 101
-----------------------------------------------------
City | MENIFEE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92584-9130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-672-1666
-----------------------------------------------------
Fax | 855-895-3627
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. RYAN B BAKER
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 858-405-8434
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------