Provider Demographics
NPI:1316254659
Name:BAKER, CAPPIE
Entity type:Individual
Prefix:
First Name:CAPPIE
Middle Name:
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 1:20930 BONITA ST
Mailing Address - Street 2:SUITE X
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-3680
Mailing Address - Country:US
Mailing Address - Phone:310-523-2161
Mailing Address - Fax:
Practice Address - Street 1:20930 BONITA ST
Practice Address - Street 2:SUITE X
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-3680
Practice Address - Country:US
Practice Address - Phone:310-523-2161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA325311223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics