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General NPI Number Information
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NPI Number | 1205971629
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Entity Type | Organization
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Legal Business Name | BAY COLONY P.A.
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2251 FM 646 RD W SUITE 150
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City | DICKINSON
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State | TX
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Zip | 77539-3235
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Country | US
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Telephone | 281-337-9000
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Fax | 281-337-9011
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Provider Business Mailing Address
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Address Line | 2251 FM 646 RD W SUITE 150
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City | DICKINSON
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State | TX
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Zip | 77539-3235
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Country | US
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Telephone | 281-337-9000
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Fax | 281-337-9011
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BALBINO BELTRE II
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Credential | D.D.S.
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Telephone | 281-337-9000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 17837
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License Number State | TX
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