Provider Demographics
NPI:1902011174
Name:BAKIOS, STEPHEN NICHOLAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:NICHOLAS
Last Name:BAKIOS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 LAMBIE CIR
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:RI
Mailing Address - Zip Code:02871-3927
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2224 PAWTUCKET AVE
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-1716
Practice Address - Country:US
Practice Address - Phone:401-435-4240
Practice Address - Fax:401-435-4245
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI803011223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1285692731OtherPRACTICE NPI
RI80301OtherSTATE LICENSE