Provider Demographics
NPI:1790018786
Name:BAYVIEW DENTAL CENTER PC
Entity Type:Organization
Organization Name:BAYVIEW DENTAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:CHUOKE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:409-948-1384
Mailing Address - Street 1:1310 34TH ST N
Mailing Address - Street 2:SUITE A
Mailing Address - City:TEXAS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77590-6570
Mailing Address - Country:US
Mailing Address - Phone:409-948-1384
Mailing Address - Fax:
Practice Address - Street 1:1310 34TH ST N
Practice Address - Street 2:SUITE A
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77590-6570
Practice Address - Country:US
Practice Address - Phone:409-948-1384
Practice Address - Fax:409-948-0523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12642122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty