Healthcare Provider Details

I. General information

NPI: 1609848308
Provider Name (Legal Business Name): BAY PEDIATRIC & ADOLESCENT DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 02/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 LOTTIE LN
FAIRHOPE AL
36532-2995
US

IV. Provider business mailing address

115 LOTTIE LN
FAIRHOPE AL
36532-2995
US

V. Phone/Fax

Practice location:
  • Phone: 251-928-5045
  • Fax: 251-929-3335
Mailing address:
  • Phone: 251-928-5045
  • Fax: 251-929-3335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM WELLS HAMMOCK
Title or Position: OWNER
Credential: DMD
Phone: 251-928-5045