Provider Demographics
NPI:1851402945
Name:J. MARK BAYLESS, DMD, INC.
Entity type:Organization
Organization Name:J. MARK BAYLESS, DMD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:BAYLESS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:831-375-9232
Mailing Address - Street 1:333 EL DORADO ST
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-4606
Mailing Address - Country:US
Mailing Address - Phone:831-375-9232
Mailing Address - Fax:831-655-6434
Practice Address - Street 1:333 EL DORADO ST
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-4606
Practice Address - Country:US
Practice Address - Phone:831-375-9232
Practice Address - Fax:831-655-6434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA315641223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty