Healthcare Provider Details

I. General information

NPI: 1427256908
Provider Name (Legal Business Name): DALE WAYNE BAKKE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 SOUTH MAIN STREET
TRIPP SD
57376-0380
US

IV. Provider business mailing address

PO BOX 380
TRIPP SD
57376-0380
US

V. Phone/Fax

Practice location:
  • Phone: 605-935-6089
  • Fax:
Mailing address:
  • Phone: 605-935-6089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberM541
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: