Provider Demographics
NPI:1962729806
Name:BAKER-WETTSTEIN ENTERPRISES L.L.C.
Entity type:Organization
Organization Name:BAKER-WETTSTEIN ENTERPRISES L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTSIT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIGHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-814-8888
Mailing Address - Street 1:5970 S COOPER RD
Mailing Address - Street 2:SUITE1
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-5393
Mailing Address - Country:US
Mailing Address - Phone:480-814-8888
Mailing Address - Fax:480-814-1553
Practice Address - Street 1:5970 S COOPER RD
Practice Address - Street 2:SUITE1
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-5393
Practice Address - Country:US
Practice Address - Phone:480-814-8888
Practice Address - Fax:480-814-1553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-03
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5899305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization