| Organization Name: | JOHNNY L BAKKER DDS PA |
| NPI Number: | 1013306158 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOHNNY L BAKKER (OWNER/DOCTOR) |
| Mailing Address: | 418 W Maple Ave Springdale |
| State: | AR US |
| Postal Code: | 727645334 |
| Phone Number: | 4797518820 |
| Fax Number: | 4797513117 |
| NPI Enumeration Date: | 01/13/2015 |
| NPI Last Update Date: | 01/13/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 2398 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AR |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |