Healthcare Provider Details

I. General information

NPI: 1053327601
Provider Name (Legal Business Name): BAY SHORE SERVCIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 RIVERSIDE DR
SALISBURY MD
21801
US

IV. Provider business mailing address

1409 WESLEY DR
SALISBURY MD
21801
US

V. Phone/Fax

Practice location:
  • Phone: 410-912-0288
  • Fax:
Mailing address:
  • Phone: 410-341-0307
  • Fax: 410-341-0308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: SUSAN ATWOOD
Title or Position: ADMINISTRATOR
Credential:
Phone: 410-341-0307