Provider Demographics
NPI:1356355242
Name:BAKER, PHILLIP ANDREW (DDS)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:ANDREW
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 1:230 N SAWYER ST
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54902-4280
Mailing Address - Country:US
Mailing Address - Phone:920-233-1030
Mailing Address - Fax:920-233-7398
Practice Address - Street 1:230 N SAWYER ST
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54902-4280
Practice Address - Country:US
Practice Address - Phone:920-233-1030
Practice Address - Fax:920-233-7398
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4436-0151223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33720600Medicaid