Provider Demographics
NPI:1104021906
Name:BAYETTE, VAHEED (DDS)
Entity Type:Individual
Prefix:
First Name:VAHEED
Middle Name:
Last Name:BAYETTE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 SPRUCE ST STE C
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-5859
Mailing Address - Country:US
Mailing Address - Phone:619-298-9839
Mailing Address - Fax:
Practice Address - Street 1:420 SPRUCE ST STE C
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-5859
Practice Address - Country:US
Practice Address - Phone:619-298-9839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41587122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist