Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | IL | |
N | 1223P0300X | Periodontist | IL |
NPI | 1053426619 |
---|---|
Provider Name | Dr. Barry Lawrence Baker |
First Address | Palatine, IL 60067-8127 |
Second Address | Palatine, IL 60067-8127 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 08/07/2007 |