Provider Demographics
NPI:1225458649
Name:BAYFRONT DENTAL PC
Entity Type:Organization
Organization Name:BAYFRONT DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:SHAESTA
Authorized Official - Middle Name:
Authorized Official - Last Name:NAJEEM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:585-787-1000
Mailing Address - Street 1:1760 EMPIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-2179
Mailing Address - Country:US
Mailing Address - Phone:585-787-1000
Mailing Address - Fax:585-787-1045
Practice Address - Street 1:1760 EMPIRE BLVD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-2179
Practice Address - Country:US
Practice Address - Phone:585-787-1000
Practice Address - Fax:585-787-1045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-24
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0456421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03875789Medicaid