Provider Demographics
NPI:1093118259
Name:MATTHEW W. BAYLESS DDS PC
Entity Type:Organization
Organization Name:MATTHEW W. BAYLESS DDS PC
Other - Org Name:SUMMER HILL DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:W
Authorized Official - Last Name:BAYLESS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:830-438-2193
Mailing Address - Street 1:19750 STATE HIGHWAY 46 W
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SPRING BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:78070-6880
Mailing Address - Country:US
Mailing Address - Phone:830-438-2193
Mailing Address - Fax:830-438-2196
Practice Address - Street 1:19750 STATE HIGHWAY 46 W
Practice Address - Street 2:SUITE 105
Practice Address - City:SPRING BRANCH
Practice Address - State:TX
Practice Address - Zip Code:78070-6880
Practice Address - Country:US
Practice Address - Phone:830-438-2193
Practice Address - Fax:830-438-2196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22467261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental