Healthcare Provider Details

I. General information

NPI: 1710901053
Provider Name (Legal Business Name): PETER T. BAYLES DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 06/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 W 4TH ST
DEQUINCY LA
70633-3321
US

IV. Provider business mailing address

824 W 4TH ST
DEQUINCY LA
70633-3321
US

V. Phone/Fax

Practice location:
  • Phone: 337-786-6221
  • Fax: 337-786-6223
Mailing address:
  • Phone: 337-786-6221
  • Fax: 337-786-6223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3756
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: