Provider Demographics
NPI:1053639963
Name:BAYLON, TEODORA NIKOLAEVA (DDS)
Entity Type:Individual
Prefix:DR
First Name:TEODORA
Middle Name:NIKOLAEVA
Last Name:BAYLON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:TEODORA
Other - Middle Name:NIKOLAEVA
Other - Last Name:PLATIKANOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2233 HAMLINE AVE N STE 320
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55113-5005
Mailing Address - Country:US
Mailing Address - Phone:651-636-0655
Mailing Address - Fax:
Practice Address - Street 1:2233 HAMLINE AVE N
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-5009
Practice Address - Country:US
Practice Address - Phone:651-636-0655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-17
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND12717122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist