Provider Demographics
NPI:1164552808
Name:BAY AREA ENDODONTICS PC
Entity Type:Organization
Organization Name:BAY AREA ENDODONTICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SULFARO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:989-894-1122
Mailing Address - Street 1:916 WASHINGTON AVENUE
Mailing Address - Street 2:SUITE 224
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708
Mailing Address - Country:US
Mailing Address - Phone:989-894-1122
Mailing Address - Fax:989-894-2626
Practice Address - Street 1:916 WASHINGTON AVENUE
Practice Address - Street 2:SUITE 224
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708
Practice Address - Country:US
Practice Address - Phone:989-894-1122
Practice Address - Fax:989-894-2626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty