=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427900356
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BAY IMPLANT AND PERIO, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2026
-----------------------------------------------------
Last Update Date | 02/12/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 514 FLORIDA AVE
-----------------------------------------------------
City | LYNN HAVEN
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32444-1736
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-832-8179
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 514 FLORIDA AVE
-----------------------------------------------------
City | LYNN HAVEN
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32444-1736
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-832-8179
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | PATRICK FITZGERALD
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 850-855-3828
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0300X
-----------------------------------------------------
Taxonomy Name | Periodontics
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------