MEDICARE: RICHARD BAKER

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	DN14256	FL

General Provider Information

NPI Number	:	1730299736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD BAKER

Provider Business Mailing Address
First Line	:	2502 N ROCKY POINT DR
Second Line	:	SUITE 1000-CREDENTIALING
City	:	TAMPA
State	:	FL
Zip	:	33607-1421
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9030 W FORT ISLAND TRL
Second Line	:	SUITE 6
City	:	CRYSTAL RIVER
State	:	FL
Zip	:	34429-2412
Country	:	US
Telephone Number	:	352-795-7316
Fax Number	:

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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Directions to “ RICHARD BAKER ” Practice Location

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