Provider Demographics
NPI:1902894041
Name:BAKER, JASON F (DDS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:F
Last Name:BAKER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 N CHURCH ST UNIT 3
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-2255
Mailing Address - Country:US
Mailing Address - Phone:773-726-3241
Mailing Address - Fax:
Practice Address - Street 1:236 MARKET ST
Practice Address - Street 2:SUITE 200
Practice Address - City:LOCUST
Practice Address - State:NC
Practice Address - Zip Code:28097-9438
Practice Address - Country:US
Practice Address - Phone:704-781-0500
Practice Address - Fax:704-781-0555
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9048122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist