Provider Demographics
NPI:1548347693
Name:BAKER, MARTIN HATHORN JR (DDS MS)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:HATHORN
Last Name:BAKER
Suffix:JR
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15609
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39404-5609
Mailing Address - Country:US
Mailing Address - Phone:601-544-2222
Mailing Address - Fax:
Practice Address - Street 1:6504 HIGHWAY 98
Practice Address - Street 2:STE G
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402
Practice Address - Country:US
Practice Address - Phone:601-544-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOR104851223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics