Provider Demographics
NPI:1356741847
Name:BAY ORAL & FACIAL SURGERY
Entity type:Organization
Organization Name:BAY ORAL & FACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:HEITZMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:850-271-8001
Mailing Address - Street 1:725 OHIO AVE
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-1757
Mailing Address - Country:US
Mailing Address - Phone:850-271-8001
Mailing Address - Fax:850-277-0390
Practice Address - Street 1:725 OHIO AVE
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444-1757
Practice Address - Country:US
Practice Address - Phone:850-271-8001
Practice Address - Fax:850-277-0390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-03
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17426261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery