Provider Demographics
NPI:1679980163
Name:BAYSIDE DENTAL CARE LLC
Entity Type:Organization
Organization Name:BAYSIDE DENTAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SYED
Authorized Official - Middle Name:Z
Authorized Official - Last Name:QUADRI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:321-726-8884
Mailing Address - Street 1:3440 BAYSIDE LAKES BLVD SE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-6843
Mailing Address - Country:US
Mailing Address - Phone:321-726-8884
Mailing Address - Fax:321-768-0568
Practice Address - Street 1:3440 BAYSIDE LAKES BLVD SE
Practice Address - Street 2:SUITE 1
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-6843
Practice Address - Country:US
Practice Address - Phone:321-726-8884
Practice Address - Fax:321-768-0568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty