Provider Demographics
NPI:1124472741
Name:BAKER, DUSTIN LEE
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:LEE
Last Name:BAKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1338 LAFAYETTE AVE NE APT 1
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49505-5044
Mailing Address - Country:US
Mailing Address - Phone:616-204-6813
Mailing Address - Fax:
Practice Address - Street 1:1338 LAFAYETTE AVE NE APT 1
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-5044
Practice Address - Country:US
Practice Address - Phone:616-204-6813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-20
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other