Provider Demographics
NPI:1336365238
Name:BAKER, KIMBERLY ANN (DDS)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ANN
Last Name:BAKER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 TOWNE CROSSING BLVD
Mailing Address - Street 2:# 180
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-2783
Mailing Address - Country:US
Mailing Address - Phone:972-270-6646
Mailing Address - Fax:
Practice Address - Street 1:3501 TOWNE CROSSING BLVD
Practice Address - Street 2:# 180
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-2783
Practice Address - Country:US
Practice Address - Phone:972-270-6646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13718122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist