Provider Demographics
NPI:1689995201
Name:BAKER, J. BRIAN (DMD)
Entity type:Individual
Prefix:DR
First Name:J. BRIAN
Middle Name:
Last Name:BAKER
Suffix:
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 1:911 E 67TH ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4612
Mailing Address - Country:US
Mailing Address - Phone:912-352-2289
Mailing Address - Fax:912-352-2042
Practice Address - Street 1:911 E 67TH ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4612
Practice Address - Country:US
Practice Address - Phone:912-352-2289
Practice Address - Fax:912-352-2042
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-17
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0120791223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics