Provider Demographics
NPI:1790960177
Name:BAY BREEZE DENTISTRY PA
Entity Type:Organization
Organization Name:BAY BREEZE DENTISTRY PA
Other - Org Name:BAY BREEZE DENTISTRY PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:VIRGINIA
Authorized Official - Last Name:SANTANA-PAINE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-610-8765
Mailing Address - Street 1:14 MANCHESTER SQ STE 215
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-8003
Mailing Address - Country:US
Mailing Address - Phone:603-610-8765
Mailing Address - Fax:603-610-8766
Practice Address - Street 1:14 MANCHESTER SQ STE 215
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-8003
Practice Address - Country:US
Practice Address - Phone:603-610-8765
Practice Address - Fax:603-610-8766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3451261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental