Provider Demographics
NPI:1699035444
Name:BAYSAC, MARY ANNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARY ANNE
Middle Name:
Last Name:BAYSAC
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 CALIFORNIA ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1379
Mailing Address - Country:US
Mailing Address - Phone:415-668-0526
Mailing Address - Fax:
Practice Address - Street 1:4200 CALIFORNIA ST
Practice Address - Street 2:SUITE 210
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1379
Practice Address - Country:US
Practice Address - Phone:415-668-0526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-25
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA529671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice