Provider Demographics
NPI:1205143419
Name:BAY RAEA ORAL & FACIAL SURGERY
Entity type:Organization
Organization Name:BAY RAEA ORAL & FACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:STIMSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:727-738-1716
Mailing Address - Street 1:5636 GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-3875
Mailing Address - Country:US
Mailing Address - Phone:727-845-3282
Mailing Address - Fax:727-937-9213
Practice Address - Street 1:5636 GRAND BLVD
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-3875
Practice Address - Country:US
Practice Address - Phone:727-845-3282
Practice Address - Fax:727-937-9213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty