Provider Demographics
NPI:1558468520
Name:BAKER, STEVEN R (DDS)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:R
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 1:940 SYLVA LN STE K2
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-5969
Mailing Address - Country:US
Mailing Address - Phone:209-532-1091
Mailing Address - Fax:209-533-3515
Practice Address - Street 1:940 SYLVA LN STE K2
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5969
Practice Address - Country:US
Practice Address - Phone:209-532-1091
Practice Address - Fax:209-533-3515
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA263351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice