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General NPI Number Information
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NPI Number | 1548387731
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Entity Type | Organization
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Legal Business Name | BAYBERRY DENTAL OFFICE
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7608 OSWEGO RD #16
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City | LIVERPOOL
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State | NY
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Zip | 13090
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Country | US
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Telephone | 315-622-3300
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Fax | 315-622-5810
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Provider Business Mailing Address
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Address Line | 7608 OSWEGO RD #16
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City | LIVERPOOL
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State | NY
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Zip | 13090
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Country | US
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Telephone | 315-622-3300
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Fax | 315-622-5810
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Authorized Official
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Title or Position | OWNER
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Name | MR. NADIR ADLY AZIZ
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Credential | DDS
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Telephone | 315-622-3300
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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 | 047097
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License Number State | NY
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