Provider Demographics
NPI:1639740780
Name:BAYLEE DENTAL PA
Entity Type:Organization
Organization Name:BAYLEE DENTAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:REGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-259-6799
Mailing Address - Street 1:12161 COUNTY ROAD 103 STE 101
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:FL
Mailing Address - Zip Code:34484-2986
Mailing Address - Country:US
Mailing Address - Phone:352-259-6799
Mailing Address - Fax:
Practice Address - Street 1:16850 S US HIGHWAY 441 STE 301
Practice Address - Street 2:
Practice Address - City:SUMMERFIELD
Practice Address - State:FL
Practice Address - Zip Code:34491-8657
Practice Address - Country:US
Practice Address - Phone:352-307-3006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty