Healthcare Provider Details

I. General information

NPI: 1215035571
Provider Name (Legal Business Name): MATTHEW BAYLESS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19750 STATE HIGHWAY 46 W STE 105
SPRING BRANCH TX
78070-6881
US

IV. Provider business mailing address

19750 STATE HIGHWAY 46 W STE 105
SPRING BRANCH TX
78070-6881
US

V. Phone/Fax

Practice location:
  • Phone: 830-438-2193
  • Fax: 830-438-2196
Mailing address:
  • Phone: 830-438-2193
  • Fax: 830-438-2196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number22467
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: