Provider Demographics
NPI:1780357160
Name:BAKULA, CHARLES STEWART (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:STEWART
Last Name:BAKULA
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 1:2821 N BALLAS RD STE 140
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2377
Mailing Address - Country:US
Mailing Address - Phone:314-432-5544
Mailing Address - Fax:314-432-7815
Practice Address - Street 1:2821 N BALLAS RD STE 140
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2377
Practice Address - Country:US
Practice Address - Phone:314-432-5544
Practice Address - Fax:314-432-7815
Is Sole Proprietor?:No
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021021223122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist