Provider Demographics
NPI:1164160412
Name:BAYSIDE ENDODONTICS
Entity Type:Organization
Organization Name:BAYSIDE ENDODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAO
Authorized Official - Suffix:
Authorized Official - Credentials:CRDH
Authorized Official - Phone:727-576-3636
Mailing Address - Street 1:275 96TH AVE N STE 7
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2526
Mailing Address - Country:US
Mailing Address - Phone:727-576-3636
Mailing Address - Fax:727-596-3636
Practice Address - Street 1:9075 SEMINOLE BLVD
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-3147
Practice Address - Country:US
Practice Address - Phone:727-576-3636
Practice Address - Fax:727-596-3636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty