MEDICARE: PEDIATRIC PRO CHILDREN'S DENTISTRY & ORTHODONTICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	27545	TX

General Provider Information

NPI Number	:	1114312154
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC PRO CHILDREN'S DENTISTRY & ORTHODONTICS

Provider Business Mailing Address
First Line	:	1234 NORTHWEST HWY
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75041-5834
Country	:	US
Telephone Number	:	214-380-5054
Fax Number	:

Provider Business Practice Location Address
First Line	:	1234 NORTHWEST HWY
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75041-5834
Country	:	US
Telephone Number	:	978-729-6801
Fax Number	:

Authorized Official
Title or Position	:	OWNER PEDIATRIC DENTIST
Name	:	DR. ALI BAYAT
Credential	:	DMD
Telephone Number	:	214-380-5054

Provider Enumeration Date	:	04/06/2015
Last Update Date	:	08/03/2015

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Directions to “PEDIATRIC PRO CHILDREN'S DENTISTRY & ORTHODONTICS ” Practice Location

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