1417068743 NPI number — DEBRA LOUISE BAKER D.D.S.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417068743 NPI number — DEBRA LOUISE BAKER D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAKER
Provider First Name:
DEBRA
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PARACHOU
Provider Other First Name:
DEBRA
Provider Other Middle Name:
LOUISE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.D.S.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1417068743
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1895 E ROSEVILLE PKWY
Provider Second Line Business Mailing Address:
SUITE 180
Provider Business Mailing Address City Name:
ROSEVILLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95661-7976
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-773-4553
Provider Business Mailing Address Fax Number:
916-773-4618

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1895 E ROSEVILLE PKWY
Provider Second Line Business Practice Location Address:
SUITE 180
Provider Business Practice Location Address City Name:
ROSEVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95661-7976
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-773-4553
Provider Business Practice Location Address Fax Number:
916-773-4618
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  45641 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1529151 . This is a "UNITED CONCORDIA PIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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