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Contact Information

BAKER PEDIATRIC DENTISTRY, PLLC
1900 JOHN ADAMS PKWY
IDAHO FALLS, ID83401
 Phone: 208-524-0644
 Fax: 208-524-6100
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pediatric Dentistry

1223P0221X
 

Dentist

122300000X
Indicates primary specialty

NPI Profile & details for BAKER PEDIATRIC DENTISTRY, PLLC

NPI Number 1407211725
LBN Legal business name BAKER PEDIATRIC DENTISTRY, PLLC
Authorized official THOMAS BAKER - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 12/31/2015
Last updated 06/18/2020 - About 6 years ago
Identifiers
ID Medicaid 28510
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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