Provider Demographics
NPI:1356776850
Name:BAY AREA PERIODONTICS AND DENTAL IMPLANTS
Entity type:Organization
Organization Name:BAY AREA PERIODONTICS AND DENTAL IMPLANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-486-6905
Mailing Address - Street 1:17201 FEATHERCRAFT LN
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4312
Mailing Address - Country:US
Mailing Address - Phone:281-486-6905
Mailing Address - Fax:
Practice Address - Street 1:17201 FEATHERCRAFT LN
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4312
Practice Address - Country:US
Practice Address - Phone:281-486-6905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental