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General NPI Number Information
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NPI Number | 1386883411
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Entity Type | Organization
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Legal Business Name | BAY DENTAL CENTER
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Dates
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Enumeration Date | 02/12/2009
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Last Update Date | 02/12/2009
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Provider Practice Location Address
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Address Line | 544 MAGNOLIA AVE
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City | PANAMA CITY
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State | FL
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Zip | 32401-3052
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Country | US
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Telephone | 850-785-5502
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Fax |
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Provider Business Mailing Address
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Address Line | 544 MAGNOLIA AVE
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City | PANAMA CITY
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State | FL
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Zip | 32401-3052
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Country | US
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Telephone | 850-785-5502
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN CHRISTOPHER COLLIAS
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Credential | DDS
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Telephone | 850-785-5502
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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 | DN16143
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License Number State | FL
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