MEDICARE: IRFAN BAKER DMD INC

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	122300000X	Dentist

General Provider Information

NPI Number	:	1275397317
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IRFAN BAKER DMD INC

Provider Business Mailing Address
First Line	:	5602 W MANCHESTER AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-4416
Country	:	US
Telephone Number	:	310-450-0300
Fax Number	:

Provider Business Practice Location Address
First Line	:	5602 W MANCHESTER AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-4416
Country	:	US
Telephone Number	:	310-450-0300
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. IRFAN BAKER
Credential	:	DMD
Telephone Number	:	407-848-7200

Provider Enumeration Date	:	02/08/2024
Last Update Date	:	02/13/2024

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