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General NPI Number Information
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NPI Number | 1649569690
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Entity Type | Organization
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Legal Business Name | KENNETH W. BAKER, D.D.S.,P.A.
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Dates
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Enumeration Date | 03/30/2011
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Last Update Date | 03/30/2011
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Provider Practice Location Address
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Address Line | 5000 N 10TH ST
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City | MCALLEN
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State | TX
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Zip | 78504-2832
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Country | US
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Telephone | 956-686-2052
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Fax | 956-682-1749
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Provider Business Mailing Address
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Address Line | 5000 N 10TH ST
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City | MCALLEN
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State | TX
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Zip | 78504-2832
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Country | US
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Telephone | 956-686-2052
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Fax | 956-682-1749
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Authorized Official
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Title or Position | DENTIST
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Name | DR. KENNETH W BAKER
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Credential | D.D.S.
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Telephone | 956-686-2052
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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 | 12405
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License Number State | TX
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