Provider Demographics
NPI:1215035571
Name:BAYLESS, MATTHEW (DDS)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:BAYLESS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19750 STATE HIGHWAY 46 W STE 105
Mailing Address - Street 2:
Mailing Address - City:SPRING BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:78070-6881
Mailing Address - Country:US
Mailing Address - Phone:830-438-2193
Mailing Address - Fax:304-382-1968
Practice Address - Street 1:19750 STATE HIGHWAY 46 W STE 105
Practice Address - Street 2:
Practice Address - City:SPRING BRANCH
Practice Address - State:TX
Practice Address - Zip Code:78070-6881
Practice Address - Country:US
Practice Address - Phone:830-438-2193
Practice Address - Fax:830-438-2196
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX224671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice