Provider Demographics
NPI:1669413993
Name:BAKER, GEORGE W JR (DMD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:W
Last Name:BAKER
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 SOUTH GREENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-2735
Mailing Address - Country:US
Mailing Address - Phone:706-882-5551
Mailing Address - Fax:706-812-8558
Practice Address - Street 1:606 SOUTH GREENWOOD ST
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-2735
Practice Address - Country:US
Practice Address - Phone:706-882-5551
Practice Address - Fax:706-812-8558
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA87451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000136848AMedicaid