Individual
DR. NILES KNIGHT BAKKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2457 N MAYFAIR RD, SUITE 203, WAUWATOSA, WI 53226-1405
(414) 258-0963
Mailing address
2457 N MAYFAIR RD, SUITE 203, WAUWATOSA, WI 53226-1405
(414) 258-0963
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
2379-015
WI
Other
Enumeration date
12/05/2006
Last updated
07/08/2007
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