Individual provider Active NPI

Jeffrey T Baker, DDS

  • Dentist
  • Shelby TWP, MI
National Provider Identifier
1487761003
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
15583 Issued in MI
Practice address
8152 25 Mile Rd
Suite C
Shelby TWP, MI 48316
Phone
(586) 992-9222
Fax
(586) 992-0814
NPI assigned
Aug 23, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 15583 MI Primary

Addresses

Primary practice location

8152 25 Mile Rd
Suite C
Shelby TWP, MI 48316

Mailing address

8152 25 Mile Rd
Suite C
Shelby TWP, MI 48316
Phone (586) 992-9222

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160122002182 MI Order and Referring Only - DentistPractitioner - Dentist 1254634330

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
15583MIMDDentist

NPI Registry JSON

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

{
    "created_epoch": "1156291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1487761003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8152 25 MILE RD",
            "address_2": "SUITE C",
            "city": "SHELBY TWP",
            "state": "MI",
            "postal_code": "48316",
            "telephone_number": "586-992-9222",
            "fax_number": "586-992-0814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8152 25 MILE RD",
            "address_2": "SUITE C",
            "city": "SHELBY TWP",
            "state": "MI",
            "postal_code": "48316",
            "telephone_number": "586-992-9222",
            "fax_number": "586-992-0814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAKER",
        "first_name": "JEFFREY",
        "middle_name": "T",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "15583",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelby TWP, MI

Sources for this page

Verify at the official NPI Registry.