Provider Demographics
NPI:1093714396
Name:BAY DENTAL ASSOCIATES SC
Entity Type:Organization
Organization Name:BAY DENTAL ASSOCIATES SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:STROMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:715-682-6675
Mailing Address - Street 1:819 LAKE SHORE DR W
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806-1443
Mailing Address - Country:US
Mailing Address - Phone:715-682-6675
Mailing Address - Fax:715-682-6747
Practice Address - Street 1:819 LAKE SHORE DR W
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806-1443
Practice Address - Country:US
Practice Address - Phone:715-682-6675
Practice Address - Fax:715-682-6747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty