MEDICARE: DR. BRIAN PAUL BAKER DMD

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	DN0012861	FL

General Provider Information

NPI Number	:	1235280637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN PAUL BAKER DMD

Provider Business Mailing Address
First Line	:	1625 S WASHINGTON AVE
Second Line	:	SUITE B
City	:	TITUSVILLE
State	:	FL
Zip	:	32780-4734
Country	:	US
Telephone Number	:	321-267-7072
Fax Number	:	321-267-4948

Provider Business Practice Location Address
First Line	:	1625 S WASHINGTON AVE
Second Line	:	SUITE B
City	:	TITUSVILLE
State	:	FL
Zip	:	32780-4734
Country	:	US
Telephone Number	:	321-267-7072
Fax Number	:	321-267-4948

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

Provider Enumeration Date	:	01/15/2007
Last Update Date	:	07/08/2007

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