Provider Demographics
NPI:1104667781
Name:BAKER, WORTH BRADLEY (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:WORTH
Middle Name:BRADLEY
Last Name:BAKER
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 LARUE APT 209
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-8319
Mailing Address - Country:US
Mailing Address - Phone:270-485-9022
Mailing Address - Fax:
Practice Address - Street 1:3695 NICHOLASVILLE RD STE 140
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-4493
Practice Address - Country:US
Practice Address - Phone:270-485-9022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY11129122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist