Provider Demographics
NPI:1528269537
Name:BAY DENTAL PC
Entity type:Organization
Organization Name:BAY DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICEPRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:VEITZ-KEENAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-934-1020
Mailing Address - Street 1:2709 OCEAN AVE APT A8
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4671
Mailing Address - Country:US
Mailing Address - Phone:718-934-1020
Mailing Address - Fax:718-934-1944
Practice Address - Street 1:2709 OCEAN AVE APT A8
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4671
Practice Address - Country:US
Practice Address - Phone:718-934-1020
Practice Address - Fax:718-934-1944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047823122300000X
NY048459122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02278628Medicaid