# BAKER, DEST, BAKER, DDS, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Kings Mountain Medicaid Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1578720967
- **Authorized official:** DR. RICHARD F DEST DDS (REGISTERED AGENT/MEMBER)
- **Authorized official phone:** (704) 547-1279

## Contact information

- **Practice address:** 107 E MOUNTAIN ST, KINGS MOUNTAIN, NC 28086-3442
- **Practice address phone:** (704) 739-4473
- **Mailing address:** 8305 UNIVERSITY EXEC PARK DR, SUITE 300, CHARLOTTE, NC 28262-1361
- **Mailing address phone:** (704) 547-1279
- **Mailing address fax:** (704) 547-8383

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 5283 | NC | Yes |

## Other

- **Enumeration date:** 05/22/2008
- **Last updated:** 05/28/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 890175T | — | NC |