Provider Demographics
NPI:1154549327
Name:BAKER, ROGER CHARLES (DDS)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:CHARLES
Last Name:BAKER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5666 FOX HOLLOW CT
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-4215
Mailing Address - Country:US
Mailing Address - Phone:419-885-2513
Mailing Address - Fax:
Practice Address - Street 1:5759 PARK CENTER CT
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-1479
Practice Address - Country:US
Practice Address - Phone:419-843-5775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH18190122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist