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General NPI Number Information
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NPI Number | 1093714396
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Entity Type | Organization
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Legal Business Name | BAY DENTAL ASSOCIATES SC
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Dates
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Enumeration Date | 07/19/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 819 LAKE SHORE DR W
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City | ASHLAND
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State | WI
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Zip | 54806-1443
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Country | US
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Telephone | 715-682-6675
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Fax | 715-682-6747
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Provider Business Mailing Address
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Address Line | 819 LAKE SHORE DR W
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City | ASHLAND
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State | WI
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Zip | 54806-1443
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Country | US
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Telephone | 715-682-6675
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Fax | 715-682-6747
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | DR. BARRY ROBERT STROMBERG
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Credential | DDS
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Telephone | 715-682-6675
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State | WI
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