Provider Demographics
NPI:1457103673
Name:BAYFRONT DENTAL LLC
Entity Type:Organization
Organization Name:BAYFRONT DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:GLORIA
Authorized Official - Last Name:GELINAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-545-1958
Mailing Address - Street 1:6475 JORDAN RD
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-4728
Mailing Address - Country:US
Mailing Address - Phone:603-545-1958
Mailing Address - Fax:
Practice Address - Street 1:6475 JORDAN RD
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-4728
Practice Address - Country:US
Practice Address - Phone:603-545-1958
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-02
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental