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General NPI Number Information
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NPI Number | 1356741847
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Entity Type | Organization
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Legal Business Name | BAY ORAL & FACIAL SURGERY
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Dates
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Enumeration Date | 09/03/2014
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Last Update Date | 09/03/2014
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Provider Practice Location Address
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Address Line | 725 OHIO AVE
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City | LYNN HAVEN
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State | FL
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Zip | 32444-1757
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Country | US
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Telephone | 850-271-8001
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Fax | 850-277-0390
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Provider Business Mailing Address
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Address Line | 725 OHIO AVE
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City | LYNN HAVEN
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State | FL
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Zip | 32444-1757
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Country | US
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Telephone | 850-271-8001
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Fax | 850-277-0390
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Authorized Official
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Title or Position | ORAL SURGEON/OWNER
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Name | DR. SCOTT JOSEPH HEITZMANN
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Credential | DMD
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Telephone | 850-271-8001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number | DN17426
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License Number State | FL
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