Provider Demographics
NPI:1063292308
Name:ISRAEL, BAYLA TARA BAHT
Entity type:Individual
Prefix:
First Name:BAYLA
Middle Name:TARA BAHT
Last Name:ISRAEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9544 BRACE ST APT 103
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-1439
Mailing Address - Country:US
Mailing Address - Phone:313-505-8726
Mailing Address - Fax:
Practice Address - Street 1:9544 BRACE ST APT 103
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-1439
Practice Address - Country:US
Practice Address - Phone:313-505-8726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant