Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 100177 | CA |
NPI | 1386935468 |
---|---|
Provider Name | Dr. Eric Christopher Baker |
First Address | Dana Point, CA 92629-3310 |
Second Address | Dana Point, CA 92629-3310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2011 |
Last Update Date | 17/03/2018 |