Provider Demographics
NPI:1609848308
Name:BAY PEDIATRIC & ADOLESCENT DENTISTRY
Entity Type:Organization
Organization Name:BAY PEDIATRIC & ADOLESCENT DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:WELLS
Authorized Official - Last Name:HAMMOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:251-928-5045
Mailing Address - Street 1:115 LOTTIE LN
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-2995
Mailing Address - Country:US
Mailing Address - Phone:251-928-5045
Mailing Address - Fax:251-929-3335
Practice Address - Street 1:115 LOTTIE LN
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-2995
Practice Address - Country:US
Practice Address - Phone:251-928-5045
Practice Address - Fax:251-929-3335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-06
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529923190Medicaid