MEDICARE: DR. ANDREA MICHELLE BAKKE DDS

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	101377	CA

General Provider Information

NPI Number	:	1336669381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREA MICHELLE BAKKE DDS

Provider Business Mailing Address
First Line	:	8035 W MANCHESTER AVE STE B
Second Line	:
City	:	PLAYA DEL REY
State	:	CA
Zip	:	90293-7985
Country	:	US
Telephone Number	:	310-822-8118
Fax Number	:

Provider Business Practice Location Address
First Line	:	3636 ROSEWOOD AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066
Country	:	US
Telephone Number	:	817-966-2948
Fax Number	:	817-966-2948

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

Provider Enumeration Date	:	06/21/2017
Last Update Date	:	09/04/2018

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