| NPI | 1063738920 |
|---|---|
| Former Name | AMANDA NICOLE BAKER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 61277) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 8998) |
| 122300000X Dentist (Licence: OH 30023394) | |
| Enumeration Date | 2010-04-15 |
| Last Update Date | 2019-06-11 |