MEDICARE: DR. DANIEL W BAKKO 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	1223P0700X	Prosthodontics	28320	TX

General Provider Information

NPI Number	:	1558618918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL W BAKKO DDS

Provider Business Mailing Address
First Line	:	5600 BABCOCK RD
Second Line	:	APT #5202
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-1811
Country	:	US
Telephone Number	:	210-567-3323
Fax Number	:

Provider Business Practice Location Address
First Line	:	5600 BABCOCK RD
Second Line	:	APT #5202
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-1811
Country	:	US
Telephone Number	:	210-567-3323
Fax Number	:

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

Provider Enumeration Date	:	08/04/2012
Last Update Date	:	08/04/2012

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