MEDICARE: JORDAN OLIVIA 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	126800000X	Dental Assistant

General Provider Information

NPI Number	:	1881542199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN OLIVIA BAKER

Provider Business Mailing Address
First Line	:	598 NANCY ST NW STE 150
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30060-1377
Country	:	US
Telephone Number	:	770-422-7630
Fax Number	:

Provider Business Practice Location Address
First Line	:	598 NANCY ST NW STE 150
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30060-1377
Country	:	US
Telephone Number	:	770-422-7630
Fax Number	:

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

Provider Enumeration Date	:	03/20/2026
Last Update Date	:	03/20/2026

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Directions to “ JORDAN OLIVIA BAKER ” Practice Location

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