MEDICARE: BRIAN P. BAKER DMD,PA

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	261QD0000X	Dental Clinic/Center	DN0012861	FL

General Provider Information

NPI Number	:	1245381920
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIAN P. BAKER DMD,PA

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	:	OWNER
Name	:	DR. BRIAN PAUL BAKER
Credential	:	D.M.D.
Telephone Number	:	321-267-7072

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	01/21/2009

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