Provider Demographics
NPI:1306908843
Name:BAYME, JEFFREY B (DMD,LLC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:B
Last Name:BAYME
Suffix:
Gender:M
Credentials:DMD,LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9150 MEDCOM ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9196
Mailing Address - Country:US
Mailing Address - Phone:843-797-0404
Mailing Address - Fax:843-797-0001
Practice Address - Street 1:9150 MEDCOM ST
Practice Address - Street 2:SUITE A
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9196
Practice Address - Country:US
Practice Address - Phone:843-797-0404
Practice Address - Fax:843-797-0001
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC584655OtherUNITED CONCORDIA TRICARE