Provider Demographics
NPI:1609936525
Name:JAMES S. BYAS, JR., D.D.S. M.S. A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:JAMES S. BYAS, JR., D.D.S. M.S. A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:SPENCER
Authorized Official - Last Name:BYAS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-608-2353
Mailing Address - Street 1:411 SOUTH LONG BEACH BLVD.
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90221
Mailing Address - Country:US
Mailing Address - Phone:310-608-2353
Mailing Address - Fax:310-943-3384
Practice Address - Street 1:411 SOUTH LONG BEACH BLVD.
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221
Practice Address - Country:US
Practice Address - Phone:310-608-2353
Practice Address - Fax:310-943-3384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA256791223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB2567901OtherMEDI-CAL