NPIMap

Organization Active NPI

Baker Pediatric Dentistry, PLLC

Doing business as Baker Pediatric Dentistry

  • Pediatric Dentistry
  • Idaho Falls, ID
National Provider Identifier
1407211725
Registry record updated Jun 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
BAKER PEDIATRIC DENTISTRY, PLLC
Doing business as
Baker Pediatric Dentistry
Practice address
1900 John Adams Pkwy
Idaho Falls, ID 83401
Phone
(208) 524-0644
Fax
(208) 524-6100
NPI assigned
Dec 31, 2015
Last updated
Jun 18, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Thomas Cecil Baker, D.M.DNPI 1376969360
Title
Owner
Phone
(208) 524-0644

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X NU
Pediatric Dentistry 1223P0221X NU Primary

Addresses

Primary practice location

1900 John Adams Pkwy
Idaho Falls, ID 83401

Mailing address

1900 John Adams Pkwy
Idaho Falls, ID 83401
Phone (208) 524-0644

Other identifiers 1

IdentifierTypeStateIssuer
28510MedicaidID

Other names 1

  • Baker Pediatric Dentistry Doing business as

National Provider Directory

National Provider Directory

Locations

1900 John Adams Pkwy
Idaho Falls, ID 83401
Phone (208) 524-0644

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1451520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592438400000",
    "number": "1407211725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 JOHN ADAMS PKWY",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "83401",
            "telephone_number": "208-524-0644",
            "fax_number": "208-524-6100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 JOHN ADAMS PKWY",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "83401",
            "telephone_number": "208-524-0644",
            "fax_number": "208-524-6100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAKER PEDIATRIC DENTISTRY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-31",
        "last_updated": "2020-06-18",
        "certification_date": "2020-06-18",
        "status": "A",
        "authorized_official_last_name": "BAKER",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "CECIL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-524-0644",
        "authorized_official_credential": "D.M.D"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "28510",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Baker Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Baker Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Idaho Falls, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.