Individual provider · NPI-1

Dr. Dwight Douglas Baker, D.D.S., M.S.

Dentist, Orthodontics and Dentofacial Orthopedics · Idaho Falls, ID

NPI number1053496083

StatusActive

Last updated in NPPESJul 8, 2007

Details

NPI: 1053496083
Entity type: Individual (NPI-1)
Name: Dr. Dwight Douglas Baker
Credential: D.D.S., M.S.
Sex: Male
Sole proprietor: Yes
Enumeration date: Oct 26, 2006
Last updated: Jul 8, 2007

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
1223X0400X	Dentist, Orthodontics and Dentofacial Orthopedics	D-1911-OR	ID	Yes

Practice location

1900 John Adams Pkwy
Idaho Falls, ID 83401-4366

Phone 208-524-0644 · Fax 208-524-6100

Mailing address

1900 John Adams Pkwy
Idaho Falls, ID 83401-4366

Phone 208-524-0644 · Fax 208-524-6100

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