Provider Demographics
NPI:1750796801
Name:BAYLIS, ALLISON (DMD)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:BAYLIS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 CAPTAIN THOMAS BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-5914
Mailing Address - Country:US
Mailing Address - Phone:206-932-3675
Mailing Address - Fax:203-934-9701
Practice Address - Street 1:141 CAPTAIN THOMAS BLVD
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-5914
Practice Address - Country:US
Practice Address - Phone:206-932-3675
Practice Address - Fax:203-934-9701
Is Sole Proprietor?:No
Enumeration Date:2014-06-27
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1146921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004011136Medicaid