| Bayliss Park Dental Group | |
|
114 1/2 S 6th St Council Bluffs IA 51501-4234 | |
| (712) 256-5048 | |
| Not Available |
| Full Name | Bayliss Park Dental Group |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 114 1/2 S 6th St, Council Bluffs, Iowa |
| Authorized Official Name and Position | Ryan Thomas Hajek (OWNER) |
| Authorized Official Contact | 6053547077 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bayliss Park Dental Group 114 1/2 S 6th St Council Bluffs IA 51501-4234 Ph: (712) 256-5048 | Bayliss Park Dental Group 114 1/2 S 6th St Council Bluffs IA 51501-4234 Ph: (712) 256-5048 |
| NPI Number | 1730551268 |
|---|---|
| Provider Enumeration Date | 10/23/2015 |
| Last Update Date | 10/23/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730551268 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 09125 (Iowa) | Primary |
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