MEDICARE: DR. MATTHEW BAYLESS DDS

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	22467	TX

General Provider Information

NPI Number	:	1215035571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW BAYLESS DDS

Provider Business Mailing Address
First Line	:	19750 STATE HIGHWAY 46 W STE 105
Second Line	:
City	:	SPRING BRANCH
State	:	TX
Zip	:	78070-6881
Country	:	US
Telephone Number	:	830-438-2193
Fax Number	:	830-438-2196

Provider Business Practice Location Address
First Line	:	19750 STATE HIGHWAY 46 W STE 105
Second Line	:
City	:	SPRING BRANCH
State	:	TX
Zip	:	78070-6881
Country	:	US
Telephone Number	:	830-438-2193
Fax Number	:	830-438-2196

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	03/26/2026

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