Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 107074 | CA |
NPI | 1013679448 |
---|---|
Provider Name | John Edward Bayless |
First Address | Monterey, CA 93940-4606 |
Second Address | Monterey, CA 93940-4606 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2021 |
Last Update Date | 13/10/2021 |