Provider Demographics
NPI:1861685158
Name:BAKOS, SCOTT M (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:M
Last Name:BAKOS
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 1:3436 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-7108
Mailing Address - Country:US
Mailing Address - Phone:239-936-3436
Mailing Address - Fax:239-936-4615
Practice Address - Street 1:3436 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-7108
Practice Address - Country:US
Practice Address - Phone:239-936-3436
Practice Address - Fax:239-936-4615
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN95331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice