Provider Demographics
NPI:1538787718
Name:JOHN M. BAKARICH, DDS, PLLC
Entity type:Organization
Organization Name:JOHN M. BAKARICH, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST, MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BAKARICH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-909-4566
Mailing Address - Street 1:355 W MARTIN LUTHER KING BLVD APT 2008
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-3079
Mailing Address - Country:US
Mailing Address - Phone:704-909-4566
Mailing Address - Fax:
Practice Address - Street 1:15810 NORTHCROSS DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078
Practice Address - Country:US
Practice Address - Phone:704-909-4566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty