Organization · NPI-2

Baker Pediatric Dentistry, PLLC

Dentist, Pediatric Dentistry · Idaho Falls, ID

NPI number1407211725

StatusActive

Last updated in NPPESJun 18, 2020

Details

NPI: 1407211725
Entity type: Organization (NPI-2)
Legal business name: Baker Pediatric Dentistry, PLLC
Organization subpart: No
Enumeration date: Dec 31, 2015
Certification date: Jun 18, 2020
Last updated: Jun 18, 2020

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
1223P0221X	Dentist, Pediatric Dentistry	–	–	Yes
122300000X	Dentist	–	–

Other names

Baker Pediatric Dentistry (Doing Business As)

Practice location

1900 John Adams Pkwy
Idaho Falls, ID 83401

Phone 208-524-0644 · Fax 208-524-6100

Mailing address

1900 John Adams Pkwy
Idaho Falls, ID 83401

Phone 208-524-0644 · Fax 208-524-6100

Authorized official

Thomas Cecil Baker
Owner
2085240644

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