Provider Demographics
NPI:1336669381
Name:BAKKE, ANDREA MICHELLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:MICHELLE
Last Name:BAKKE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8035 W MANCHESTER AVE STE B
Mailing Address - Street 2:
Mailing Address - City:PLAYA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90293-7985
Mailing Address - Country:US
Mailing Address - Phone:310-822-8118
Mailing Address - Fax:
Practice Address - Street 1:3636 ROSEWOOD AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066
Practice Address - Country:US
Practice Address - Phone:817-966-2948
Practice Address - Fax:817-966-2948
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1013771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice