=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770574287
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES A BAKER I DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/03/2005
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8301 S WALKER AVE STE 101
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73139-9416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-636-4230
-----------------------------------------------------
Fax | 405-634-7994
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 108811
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73101-8811
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-848-7974
-----------------------------------------------------
Fax | 405-848-0033
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number | 3900
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------