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General NPI Number Information
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NPI Number | 1760559082
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Entity Type | Organization
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Legal Business Name | DECATUR DENTAL SERVICES
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 447 E LINE ST
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City | GENEVA
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State | IN
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Zip | 46740-8936
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Country | US
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Telephone | 260-368-7500
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Fax | 260-368-7167
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Provider Business Mailing Address
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Address Line | 447 E LINE ST
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City | GENEVA
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State | IN
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Zip | 46740-8936
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Country | US
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Telephone | 260-368-7500
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. DAVID C BAKER
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Credential |
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Telephone | 260-368-7500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12010412
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License Number State | IN
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