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General NPI Number Information
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NPI Number | 1336669381
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Entity Type | Individual
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Provider Name | ANDREA MICHELLE BAKKE DDS
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Gender | Female
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Dates
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Enumeration Date | 06/21/2017
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Last Update Date | 09/04/2018
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Provider Practice Location Address
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Address Line | 3636 ROSEWOOD AVE
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City | LOS ANGELES
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State | CA
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Zip | 90066
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Country | US
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Telephone | 817-966-2948
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Fax | 817-966-2948
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Provider Business Mailing Address
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Address Line | 8035 W MANCHESTER AVE STE B
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City | PLAYA DEL REY
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State | CA
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Zip | 90293-7985
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Country | US
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Telephone | 310-822-8118
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 101377
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License Number State | CA
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