Provider Demographics
NPI:1366484511
Name:BAKKER, JOHNNY L (DDS)
Entity Type:Individual
Prefix:MR
First Name:JOHNNY
Middle Name:L
Last Name:BAKKER
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 1:418 W MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-5334
Mailing Address - Country:US
Mailing Address - Phone:479-751-8820
Mailing Address - Fax:479-751-3117
Practice Address - Street 1:418 W MAPLE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-5334
Practice Address - Country:US
Practice Address - Phone:479-751-8820
Practice Address - Fax:479-751-3117
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR23981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice