Provider Demographics
NPI:1215075791
Name:BAKER, BRYAN SCOTT (DDS)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:SCOTT
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 1:2000 MALLORY LN STE 130
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-8231
Mailing Address - Country:US
Mailing Address - Phone:310-760-1035
Mailing Address - Fax:
Practice Address - Street 1:8124 SCHWEITZER PLACE
Practice Address - Street 2:
Practice Address - City:ARRINGTON
Practice Address - State:TN
Practice Address - Zip Code:37014
Practice Address - Country:US
Practice Address - Phone:310-760-1035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43417122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty