Provider Demographics
NPI:1154489656
Name:BAKKE, NILES KNIGHT (DDS)
Entity Type:Individual
Prefix:DR
First Name:NILES
Middle Name:KNIGHT
Last Name:BAKKE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2457 N MAYFAIR RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-1405
Mailing Address - Country:US
Mailing Address - Phone:414-258-0963
Mailing Address - Fax:
Practice Address - Street 1:2457 N MAYFAIR RD
Practice Address - Street 2:SUITE 203
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-1405
Practice Address - Country:US
Practice Address - Phone:414-258-0963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2379-0151223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics