Provider Demographics
NPI:1821173188
Name:BAY VIEW DENTAL CARE, LLP
Entity Type:Organization
Organization Name:BAY VIEW DENTAL CARE, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PERSICH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:414-482-2090
Mailing Address - Street 1:3380 S KINNICKINNIC AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-3159
Mailing Address - Country:US
Mailing Address - Phone:414-482-2090
Mailing Address - Fax:
Practice Address - Street 1:3380 S KINNICKINNIC AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53207-3159
Practice Address - Country:US
Practice Address - Phone:414-482-2090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50016441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38364400Medicaid