Provider Demographics
NPI:1184766065
Name:BAKLAND, LEIF K (DDS)
Entity type:Individual
Prefix:
First Name:LEIF
Middle Name:K
Last Name:BAKLAND
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 1:37 1/2 FORRESTER ST
Mailing Address - Street 2:PROFESSIONAL BUILDING
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950
Mailing Address - Country:US
Mailing Address - Phone:978-465-8492
Mailing Address - Fax:978-465-2191
Practice Address - Street 1:37 FORRESTER ST
Practice Address - Street 2:PROFESSIONAL BUILDING
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-1935
Practice Address - Country:US
Practice Address - Phone:978-465-8492
Practice Address - Fax:978-465-2191
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA145741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice