Basic Information
| Provider Information | |||||||||
| NPI: | 1497194765 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAKER | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | ROBERT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2310 HOLMES ST | ||||||||
| Address2: | STE 800 | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641082602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162182523 | ||||||||
| FaxNumber: | 8162856923 | ||||||||
| Practice Location | |||||||||
| Address1: | 2101 CHARLOTTE ST | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 64108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164040500 | ||||||||
| FaxNumber: | 8164044359 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2013 | ||||||||
| LastUpdateDate: | 07/12/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 2013019682 | MO | N | Dental Providers | Dentist | 1223S0112X | 2013019682 | MO | Y | Dental Providers | Dentist | Oral and Maxillofacial Surgery |
No ID Information.