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General NPI Number Information
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NPI Number | 1467300350
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Entity Type | Organization
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Legal Business Name | BAYSIDE DENTAL OF MESQUITE PLLC
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Dates
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Enumeration Date | 03/18/2026
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Last Update Date | 03/18/2026
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Provider Practice Location Address
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Address Line | 5938 W PARKER RD
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City | PLANO
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State | TX
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Zip | 75093-6438
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Country | US
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Telephone | 972-608-1811
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Fax |
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Provider Business Mailing Address
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Address Line | 5938 W PARKER RD
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City | PLANO
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State | TX
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Zip | 75093-6438
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Country | US
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Telephone | 972-608-1811
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LOI TA
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Credential | DDS
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Telephone | 972-608-1811
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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 |
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License Number State |
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