Provider Demographics
NPI:1174078810
Name:BAY AREA JAW AND FACIAL SURGERY LLC
Entity type:Organization
Organization Name:BAY AREA JAW AND FACIAL SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:BARBICK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:352-258-6218
Mailing Address - Street 1:14005 N DALE MABRY HWY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-2401
Mailing Address - Country:US
Mailing Address - Phone:813-264-2286
Mailing Address - Fax:813-264-2091
Practice Address - Street 1:1993 COUNTY ROAD 1
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-2833
Practice Address - Country:US
Practice Address - Phone:727-400-3414
Practice Address - Fax:727-738-0472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN180161223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty