Provider Demographics
NPI:1083037345
Name:BAYBARS ORTHODONTICS LLC
Entity Type:Organization
Organization Name:BAYBARS ORTHODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARKAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:904-345-9413
Mailing Address - Street 1:28 S 14TH ST
Mailing Address - Street 2:
Mailing Address - City:QUAKERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18951-1147
Mailing Address - Country:US
Mailing Address - Phone:215-529-6000
Mailing Address - Fax:215-646-6166
Practice Address - Street 1:28 S 14TH ST
Practice Address - Street 2:
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951-1147
Practice Address - Country:US
Practice Address - Phone:215-529-6000
Practice Address - Fax:215-646-6166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-22
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0382341223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty