Provider Demographics
NPI:1528284163
Name:BAKEMAN, ELIZABETH M (DDS)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:BAKEMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2757 LEONARD ST NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-5807
Mailing Address - Country:US
Mailing Address - Phone:616-940-0481
Mailing Address - Fax:616-940-0486
Practice Address - Street 1:2757 LEONARD ST NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-5807
Practice Address - Country:US
Practice Address - Phone:616-940-0481
Practice Address - Fax:616-940-0486
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901013486122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist