MEDICARE: DR. TALA 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	122300000X	Dentist	111610	CA

General Provider Information

NPI Number	:	1710872338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TALA BAKER DMD

Provider Business Mailing Address
First Line	:	12602 SPRINGBROOK DR UNIT C
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-5014
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	169 S RANCHO SANTA FE RD
Second Line	:
City	:	SAN MARCOS
State	:	CA
Zip	:	92078-2501
Country	:	US
Telephone Number	:	760-916-1191
Fax Number	:

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

Provider Enumeration Date	:	06/12/2025
Last Update Date	:	06/12/2025

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