Provider Demographics
NPI:1821114646
Name:BYLIS, PAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:BYLIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1916 CRAIN HWY S
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-5563
Mailing Address - Country:US
Mailing Address - Phone:410-969-2177
Mailing Address - Fax:410-969-2182
Practice Address - Street 1:1916 CRAIN HWY S
Practice Address - Street 2:SUITE 3
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5563
Practice Address - Country:US
Practice Address - Phone:410-969-2177
Practice Address - Fax:410-969-2182
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD95811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice