Provider Demographics
NPI:1962692012
Name:BAKAEN, KARMEN J, DDS A PROF CORP.
Entity type:Organization
Organization Name:BAKAEN, KARMEN J, DDS A PROF CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKAEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-564-9000
Mailing Address - Street 1:1710 E 17TH ST STE E
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-8622
Mailing Address - Country:US
Mailing Address - Phone:714-564-9000
Mailing Address - Fax:714-564-9024
Practice Address - Street 1:1710 E 17TH ST STE E
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-8622
Practice Address - Country:US
Practice Address - Phone:714-564-9000
Practice Address - Fax:714-564-9024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46360261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB46360OtherDENTICAL