Provider Demographics
NPI:1215458823
Name:BAKER, MORTON (DMD)
Entity type:Individual
Prefix:DR
First Name:MORTON
Middle Name:
Last Name:BAKER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 S HULEN ST STE 205
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-1500
Mailing Address - Country:US
Mailing Address - Phone:817-924-0506
Mailing Address - Fax:817-924-0519
Practice Address - Street 1:2800 S HULEN ST STE 205
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-1500
Practice Address - Country:US
Practice Address - Phone:817-924-0506
Practice Address - Fax:817-924-0519
Is Sole Proprietor?:No
Enumeration Date:2017-07-05
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33372122300000X
MO20170229631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Yes122300000XDental ProvidersDentist