Provider Demographics
NPI:1316340342
Name:SHAYAN BAYAT, DDS, INC
Entity type:Organization
Organization Name:SHAYAN BAYAT, DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SHAYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAYAT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-541-3169
Mailing Address - Street 1:638 CLAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-3232
Mailing Address - Country:US
Mailing Address - Phone:510-541-3169
Mailing Address - Fax:
Practice Address - Street 1:1500 TARA HILLS DR
Practice Address - Street 2:SUITE 104
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-2577
Practice Address - Country:US
Practice Address - Phone:510-724-7474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-05
Last Update Date:2014-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62864122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty