Provider Demographics
NPI:1487841029
Name:BAYLOSIS, JAXIMILLIAN P (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAXIMILLIAN
Middle Name:P
Last Name:BAYLOSIS
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:FOURTH & INNERLOOP RD
Mailing Address - Street 2:BLDG #171
Mailing Address - City:FORT IRWIN
Mailing Address - State:CA
Mailing Address - Zip Code:92310
Mailing Address - Country:US
Mailing Address - Phone:760-380-4990
Mailing Address - Fax:
Practice Address - Street 1:FOURTH & INNERLOOP RD
Practice Address - Street 2:BLDG #171
Practice Address - City:FORT IRWIN
Practice Address - State:CA
Practice Address - Zip Code:92310
Practice Address - Country:US
Practice Address - Phone:760-380-4990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-27
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56389122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist