Provider Demographics
NPI:1316380066
Name:BAKKAR, MOHAMMED OTHMAN (DDS)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:OTHMAN
Last Name:BAKKAR
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 1:2124 CORNELL RD. DEPARTMENT OF ENDODONTICS
Mailing Address - Street 2:SCHOOL OF DENTAL MEDICINE - CASE WESTERN RESERVE UNIVER
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-4905
Mailing Address - Country:US
Mailing Address - Phone:216-368-3236
Mailing Address - Fax:216-368-3204
Practice Address - Street 1:2124 CORNELL RD. DEPARTMENT OF ENDODONTICS
Practice Address - Street 2:SCHOOL OF DENTAL MEDICINE - CASE WESTERN RESERVE UNIVER
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-4905
Practice Address - Country:US
Practice Address - Phone:216-368-3236
Practice Address - Fax:216-368-3204
Is Sole Proprietor?:No
Enumeration Date:2013-04-12
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRES32401223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics