Provider Demographics
NPI:1174723001
Name:BAKER, GREGORY (DDS)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:
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 1:18 BUCK RD
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03755-2700
Mailing Address - Country:US
Mailing Address - Phone:603-643-1552
Mailing Address - Fax:603-643-6697
Practice Address - Street 1:18 BUCK RD
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:NH
Practice Address - Zip Code:03755-2700
Practice Address - Country:US
Practice Address - Phone:603-643-1552
Practice Address - Fax:603-643-6697
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH17311223X0400X
VT016-00008491223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics