Provider Demographics
NPI:1851507297
Name:BAKKE, ANGELA A (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:A
Last Name:BAKKE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3636 CHAMBLEE TUCKER RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-4418
Mailing Address - Country:US
Mailing Address - Phone:770-938-9521
Mailing Address - Fax:770-938-1927
Practice Address - Street 1:3636 CHAMBLEE TUCKER RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-4418
Practice Address - Country:US
Practice Address - Phone:770-938-9521
Practice Address - Fax:770-938-1927
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA108691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA581985565OtherTIN