Provider Demographics
NPI:1518172428
Name:MARY C BAKER DDS PC
Entity type:Organization
Organization Name:MARY C BAKER DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:524-457-5771
Mailing Address - Street 1:1101 S HUNTINGTON ST
Mailing Address - Street 2:STE 4
Mailing Address - City:SYRACUSE
Mailing Address - State:IN
Mailing Address - Zip Code:46567-1981
Mailing Address - Country:US
Mailing Address - Phone:524-457-5771
Mailing Address - Fax:524-457-5771
Practice Address - Street 1:1101 S HUNTINGTON ST
Practice Address - Street 2:STE 4
Practice Address - City:SYRACUSE
Practice Address - State:IN
Practice Address - Zip Code:46567-1981
Practice Address - Country:US
Practice Address - Phone:524-457-5771
Practice Address - Fax:524-457-5771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010687122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty