Provider Demographics
NPI:1205598315
Name:BAICBCCKMFA LLC
Entity type:Organization
Organization Name:BAICBCCKMFA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:TROUT
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:912-355-1512
Mailing Address - Street 1:P.O. BOX 401
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31402
Mailing Address - Country:US
Mailing Address - Phone:912-355-1512
Mailing Address - Fax:912-330-1018
Practice Address - Street 1:5209 PAULSEN STREET
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4804
Practice Address - Country:US
Practice Address - Phone:912-355-1512
Practice Address - Fax:912-330-1018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty