MEDICARE: DR. LEFTER J BAKLAS DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	14384	TX

General Provider Information

NPI Number	:	1376758169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEFTER J BAKLAS DMD

Provider Business Mailing Address
First Line	:	2318 NW MILITARY HWY
Second Line	:	STE. 101
City	:	SAN ANTONIO
State	:	TX
Zip	:	78231-2539
Country	:	US
Telephone Number	:	210-342-9678
Fax Number	:

Provider Business Practice Location Address
First Line	:	2318 NW MILITARY HWY
Second Line	:	STE. 101
City	:	SAN ANTONIO
State	:	TX
Zip	:	78231-2539
Country	:	US
Telephone Number	:	210-342-9678
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	07/08/2007

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