Provider Demographics
NPI:1871106880
Name:BAKER, BRYAN JOSEPH (DMD)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:JOSEPH
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 1:142 SW 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-4716
Mailing Address - Country:US
Mailing Address - Phone:541-837-1673
Mailing Address - Fax:
Practice Address - Street 1:142 SW 2ND ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-4716
Practice Address - Country:US
Practice Address - Phone:541-837-1442
Practice Address - Fax:541-516-4055
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2021-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD113221223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice