Provider Demographics
NPI:1437117843
Name:BAYDYUK, KOSTYANTYN (DDS)
Entity Type:Individual
Prefix:
First Name:KOSTYANTYN
Middle Name:
Last Name:BAYDYUK
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 1:3049 N HIGH SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:SPEEDWAY
Mailing Address - State:IN
Mailing Address - Zip Code:46224-2001
Mailing Address - Country:US
Mailing Address - Phone:317-293-0471
Mailing Address - Fax:317-293-0472
Practice Address - Street 1:3049 N HIGH SCHOOL RD
Practice Address - Street 2:
Practice Address - City:SPEEDWAY
Practice Address - State:IN
Practice Address - Zip Code:46224-2001
Practice Address - Country:US
Practice Address - Phone:317-293-0471
Practice Address - Fax:317-293-0472
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010696A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice