Provider Demographics
NPI:1669182291
Name:BAKER SQUARE PERIODONTICS AND IMPLANT DENTISTRY, LLC
Entity type:Organization
Organization Name:BAKER SQUARE PERIODONTICS AND IMPLANT DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERIODONTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHESTINE
Authorized Official - Middle Name:GUEVARRA
Authorized Official - Last Name:TOTH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:513-899-7186
Mailing Address - Street 1:5032 APPALOOSA CIR
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:OH
Mailing Address - Zip Code:45152-8294
Mailing Address - Country:US
Mailing Address - Phone:513-899-7186
Mailing Address - Fax:513-899-7237
Practice Address - Street 1:5032 APPALOOSA CIR
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:OH
Practice Address - Zip Code:45152-8294
Practice Address - Country:US
Practice Address - Phone:513-899-7186
Practice Address - Fax:513-899-7237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-05
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty