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General NPI Number Information
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NPI Number | 1316340342
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Entity Type | Organization
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Legal Business Name | SHAYAN BAYAT, DDS, INC
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Dates
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Enumeration Date | 10/05/2014
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Last Update Date | 10/05/2014
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Provider Practice Location Address
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Address Line | 1500 TARA HILLS DR SUITE 104
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City | PINOLE
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State | CA
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Zip | 94564-2577
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Country | US
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Telephone | 510-724-7474
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Fax |
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Provider Business Mailing Address
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Address Line | 638 CLAYTON AVE
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City | EL CERRITO
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State | CA
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Zip | 94530-3232
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Country | US
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Telephone | 510-541-3169
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Fax |
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | SHAYAN BAYAT
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Credential | D.D.S.
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Telephone | 510-541-3169
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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 | 62864
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License Number State | CA
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