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General NPI Number Information
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NPI Number | 1942325931
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Entity Type | Organization
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Legal Business Name | J NEWSOM BAKER, DDS, PC
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 07/16/2012
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Provider Practice Location Address
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Address Line | 1618 E. LAMAR ALEXANDER PKWY
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City | MARYVILLE
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State | TN
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Zip | 38704-6206
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Country | US
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Telephone | 865-984-7311
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Fax |
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Provider Business Mailing Address
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Address Line | 1618 E. LAMAR ALEXANDER PKWY
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City | MARYVILLE
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State | TN
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Zip | 38704-6206
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Country | US
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Telephone | 865-984-7311
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. J NEWSOM BAKER
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Credential |
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Telephone | 865-984-7311
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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 |
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License Number State | TN
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