Provider Demographics
NPI:1336201797
Name:APPLE VALLEY DENTAL CARE
Entity Type:Organization
Organization Name:APPLE VALLEY DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DM
Authorized Official - Last Name:BAKKEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-432-5509
Mailing Address - Street 1:14635 PENNOCK AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-6430
Mailing Address - Country:US
Mailing Address - Phone:952-432-5509
Mailing Address - Fax:952-891-4894
Practice Address - Street 1:14635 PENNOCK AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-6430
Practice Address - Country:US
Practice Address - Phone:952-432-5509
Practice Address - Fax:952-891-4894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND10867122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty