Healthcare Provider Details

I. General information

NPI: 1831024660
Provider Name (Legal Business Name): BAY HARBOR DENTAL, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 BRICK BLVD
BRICK NJ
08723-7922
US

IV. Provider business mailing address

80 S WHITE HORSE PIKE STE 5A
HAMMONTON NJ
08037-1862
US

V. Phone/Fax

Practice location:
  • Phone: 732-778-4905
  • Fax:
Mailing address:
  • Phone: 732-778-4905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RYAN PANNORFI
Title or Position: DENTIST/OWNER
Credential: DMD
Phone: 732-778-4905