Organization
BAKER PEDIATRIC DENTISTRY, PLLC
Active
Other names
Baker Pediatric Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS CECIL BAKER D.M.D (OWNER)
(208) 524-0644
Entity
Organization
Contact information
Practice address
1900 JOHN ADAMS PKWY, IDAHO FALLS, ID 83401
(208) 524-0644
(208) 524-6100
Mailing address
1900 JOHN ADAMS PKWY, IDAHO FALLS, ID 83401
(208) 524-0644
(208) 524-6100
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
28510
—
ID
Enumeration date
12/31/2015
Last updated
06/18/2020
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