Baker, Mark Ensio

Baker, Mark Ensio is an individual health care provider with primary practice located at 165 N 14Th Ave , Pocatello ID 83201-4146. He recently has only one registered license in Dental Providers / Oral and Maxillofacial Surgery, which is considered as his primary health care specialty. Baker, Mark Ensio can be contacted via phone (208) 232-2807.

Contact Information

Primary practice address
165 N 14Th Ave Pocatello ID 83201-4146
Phone: (208) 232-2807
Fax: (208) 232-8118
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Oral and Maxillofacial Surgery 1223S0112X D3016 Idaho

Profile Details

NPI number 1184798811
LBN Legal business name Baker, Mark Ensio
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 17th, 2006
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1184798811 NPPES
Idaho Other 60806 BLUE CROSS
Idaho Other 000010010306 BLUE CROSS

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