Provider Demographics
NPI:1780866566
Name:BAKKE, CHRISTOPHER THROAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:THROAN
Last Name:BAKKE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 ROSWELL RD
Mailing Address - Street 2:BUILDING #200
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-3940
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1735 ROSWELL RD
Practice Address - Street 2:BUILDING #200
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-3940
Practice Address - Country:US
Practice Address - Phone:770-973-4214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA106611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice