MEDICARE: BAYSHORE DENTAL SC

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	332BC3200X	Customized Equipment (DME)
2	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1790399665
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAYSHORE DENTAL SC

Provider Business Mailing Address
First Line	:	400 E SILVER SPRING DR
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53217-5224
Country	:	US
Telephone Number	:	414-332-6010
Fax Number	:	414-322-1850

Provider Business Practice Location Address
First Line	:	400 E SILVER SPRING DR
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53217-5224
Country	:	US
Telephone Number	:	414-332-6010
Fax Number	:	414-322-1850

Authorized Official
Title or Position	:	OWNER
Name	:	GAURI PATEL
Credential	:	DDS
Telephone Number	:	414-332-6010

Provider Enumeration Date	:	09/08/2020
Last Update Date	:	09/08/2020

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Directions to “BAYSHORE DENTAL SC ” Practice Location

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