MEDICARE: AUSTIN LEE BAKER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	4725	AR

General Provider Information

NPI Number	:	1043703085
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUSTIN LEE BAKER DDS

Provider Business Mailing Address
First Line	:	3489 BELLA VISTA WAY STE D
Second Line	:
City	:	BELLA VISTA
State	:	AR
Zip	:	72714-5740
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3489 BELLA VISTA WAY STE D
Second Line	:
City	:	BELLA VISTA
State	:	AR
Zip	:	72714-5740
Country	:	US
Telephone Number	:	479-469-8710
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2018
Last Update Date	:	03/14/2024

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