Susan Michelle Baker, DDS – Public Health Dentistry

Key facts

NPI: 1003817271
Entity type: Individual (NPI type 1)
Primary specialty: Public Health Dentistry 1223D0001X
License: 6413406-9922 (UT)
Practice address: 1215 E Snow Canyon Pkwy Unit 402
Ivins, UT 84738-6818
Phone: (435) 341-0028
Fax: (435) 703-9960
NPI assigned: Aug 9, 2005
Sex: Female
Sole proprietor: No

Medicare participation

Medicare fee-for-service enrollment: Enrolled in UT
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20160107002295	UT	Order and Referring Only - Dentist Practitioner - Dentist	5294037289

National Provider Directory

Medicare enrollment (NPD): Yes

State licenses

License	State	Type	Specialty
9648	MD	MD	Dentist

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Dentist	122300000X	9648	MD
Public Health Dentistry	1223D0001X	6413406-9922	UT	Yes

Addresses

Primary practice location

1215 E Snow Canyon Pkwy Unit 402
Ivins, UT 84738-6818

Mailing address

1215 E Snow Canyon Pkwy Unit 402
Ivins, UT 84738-6818
Phone (435) 341-0028

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 22, 2023.

{
    "created_epoch": "1123545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679443200000",
    "number": "1003817271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1215 E SNOW CANYON PKWY UNIT 402",
            "city": "IVINS",
            "state": "UT",
            "postal_code": "847386818",
            "telephone_number": "435-341-0028",
            "fax_number": "435-656-4623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1215 E SNOW CANYON PKWY UNIT 402",
            "city": "IVINS",
            "state": "UT",
            "postal_code": "847386818",
            "telephone_number": "435-341-0028",
            "fax_number": "435-703-9960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAKER",
        "first_name": "SUSAN",
        "middle_name": "MICHELLE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-09",
        "last_updated": "2023-03-22",
        "certification_date": "2023-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MD",
            "license": "9648",
            "primary": false
        },
        {
            "code": "1223D0001X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Public Health",
            "state": "UT",
            "license": "6413406-9922",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ivins, UT

All providers in Ivins, UT · Public Health Dentistry in Utah

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 22, 2023. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.