Provider Demographics
NPI:1891909388
Name:BAYLIFF FAMILY DENTISTRY
Entity Type:Organization
Organization Name:BAYLIFF FAMILY DENTISTRY
Other - Org Name:DR. JERRY GREEN BAYLIFF JR. DDS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:GREEN
Authorized Official - Last Name:BAYLIFF
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-599-6641
Mailing Address - Street 1:441 S MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:ROXBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27573-5123
Mailing Address - Country:US
Mailing Address - Phone:336-599-6641
Mailing Address - Fax:336-599-7182
Practice Address - Street 1:441 S MORGAN ST
Practice Address - Street 2:
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27573-5123
Practice Address - Country:US
Practice Address - Phone:336-599-6641
Practice Address - Fax:336-599-7182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6119122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty