Provider Demographics
NPI:1043534829
Name:TIMOTHY P. BAKELAAR, D.M.D, PLLC
Entity Type:Organization
Organization Name:TIMOTHY P. BAKELAAR, D.M.D, PLLC
Other - Org Name:BARTLETT PEDIATRIC DENTISTRY AND ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WENDI
Authorized Official - Middle Name:
Authorized Official - Last Name:STUHR
Authorized Official - Suffix:
Authorized Official - Credentials:RDA
Authorized Official - Phone:901-382-1564
Mailing Address - Street 1:3071 KIRBY WHITTEN RD
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-2822
Mailing Address - Country:US
Mailing Address - Phone:901-382-1564
Mailing Address - Fax:901-382-0657
Practice Address - Street 1:3071 KIRBY WHITTEN RD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-2822
Practice Address - Country:US
Practice Address - Phone:901-382-1564
Practice Address - Fax:901-382-0657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-23
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty