Provider Demographics
NPI:1194813220
Name:BAKER, RONIA M
Entity type:Individual
Prefix:
First Name:RONIA
Middle Name:M
Last Name:BAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 NE 125TH ST
Mailing Address - Street 2:201
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-5800
Mailing Address - Country:US
Mailing Address - Phone:305-899-7979
Mailing Address - Fax:
Practice Address - Street 1:1075 NE 125TH ST
Practice Address - Street 2:201
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-5800
Practice Address - Country:US
Practice Address - Phone:305-899-7979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN161291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice