Provider Demographics
NPI:1023450681
Name:BAYCOVE FAMILY AND COSMETIC DENTISTRY LLC
Entity type:Organization
Organization Name:BAYCOVE FAMILY AND COSMETIC DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:Z
Authorized Official - Last Name:BENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:410-384-9030
Mailing Address - Street 1:780 RITCHIE HWY
Mailing Address - Street 2:SUITE S 30
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-4135
Mailing Address - Country:US
Mailing Address - Phone:410-384-9030
Mailing Address - Fax:
Practice Address - Street 1:780 RITCHIE HWY
Practice Address - Street 2:SUITE S 30
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-4135
Practice Address - Country:US
Practice Address - Phone:410-384-9030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13157122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty