Provider Demographics
NPI:1730351404
Name:CRAIG BAKER DMD PL
Entity type:Organization
Organization Name:CRAIG BAKER DMD PL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:813-451-9658
Mailing Address - Street 1:13501 ICOT BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33760-3729
Mailing Address - Country:US
Mailing Address - Phone:727-531-4462
Mailing Address - Fax:727-210-1754
Practice Address - Street 1:13501 ICOT BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-3729
Practice Address - Country:US
Practice Address - Phone:727-531-4462
Practice Address - Fax:727-210-1754
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CRAIG BAKER DMD PL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-02
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 17163122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty