Provider Demographics
NPI:1851400550
Name:BAYSIDE DENTAL PA
Entity Type:Organization
Organization Name:BAYSIDE DENTAL PA
Other - Org Name:BAYSIDE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:H
Authorized Official - Last Name:DU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-488-3626
Mailing Address - Street 1:2323 CLEAR LAKE CITY BLVD SUITE 140
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77062
Mailing Address - Country:US
Mailing Address - Phone:281-488-3626
Mailing Address - Fax:281-486-4766
Practice Address - Street 1:2323 CLEAR LAKE CITY BLVD SUITE 140
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77062
Practice Address - Country:US
Practice Address - Phone:281-488-3626
Practice Address - Fax:281-486-4766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20694122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty