MEDICARE: DR. BRUCE ARTHUR BAKER D.D.S.

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	9735	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699832410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE ARTHUR BAKER D.D.S.

Provider Business Mailing Address
First Line	:	415 N 2ND ST
Second Line	:	SUITE 2 D
City	:	TOWER
State	:	MN
Zip	:	55790-0417
Country	:	US
Telephone Number	:	218-753-2405
Fax Number	:	218-361-3277

Provider Business Practice Location Address
First Line	:	415 N 2ND ST
Second Line	:	SUITE 2 D
City	:	TOWER
State	:	MN
Zip	:	55790-0417
Country	:	US
Telephone Number	:	218-753-2405
Fax Number	:	218-361-3277

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

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	03/19/2014

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