Healthcare Provider Details

I. General information

NPI: 1902011174
Provider Name (Legal Business Name): STEPHEN NICHOLAS BAKIOS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 09/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2224 PAWTUCKET AVE
EAST PROVIDENCE RI
02914-1716
US

IV. Provider business mailing address

120 LAMBIE CIR
PORTSMOUTH RI
02871-3927
US

V. Phone/Fax

Practice location:
  • Phone: 401-435-4240
  • Fax: 401-435-4245
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number80301
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: