Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 9648 | MD |
Y | 1223D0001X | Dental Public Health | 6413406-9922 | UT |
NPI | 1003817271 |
---|---|
Provider Name | Dr. Susan Michelle Baker |
First Address | Saint George, UT 84770-5350 |
Second Address | Saint George, UT 84770-5350 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2005 |
Last Update Date | 04/08/2008 |