Provider Demographics
NPI:1225501331
Name:BASKAKOV, ANDREI (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREI
Middle Name:
Last Name:BASKAKOV
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 1:16981 E QUINCY AVE # D1-D3
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-2769
Mailing Address - Country:US
Mailing Address - Phone:303-617-8400
Mailing Address - Fax:
Practice Address - Street 1:16981 E QUINCY AVE # D1-D3
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80015-2769
Practice Address - Country:US
Practice Address - Phone:303-617-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002038481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice