Provider Demographics
NPI:1639397268
Name:ABDUL WALI BAYAZ, DDS, INC.
Entity Type:Organization
Organization Name:ABDUL WALI BAYAZ, DDS, INC.
Other - Org Name:MACLAY BROMONT FAMILY DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:WALI
Authorized Official - Last Name:BAYAZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-781-0004
Mailing Address - Street 1:14435 HAMLIN ST STE 104
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-6205
Mailing Address - Country:US
Mailing Address - Phone:818-898-0004
Mailing Address - Fax:818-787-0035
Practice Address - Street 1:14435 HAMLIN ST STE 104
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-6205
Practice Address - Country:US
Practice Address - Phone:818-898-0004
Practice Address - Fax:818-787-0035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49469122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty