Provider Demographics
NPI:1487761003
Name:BAKER, JEFFREY T (DDS)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:T
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 1:8152 25 MILE RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48316
Mailing Address - Country:US
Mailing Address - Phone:586-992-9222
Mailing Address - Fax:586-992-0814
Practice Address - Street 1:8152 25 MILE RD
Practice Address - Street 2:SUITE C
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48316
Practice Address - Country:US
Practice Address - Phone:586-992-9222
Practice Address - Fax:586-992-0814
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI15583122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist