Provider Demographics
NPI:1356032726
Name:DR BAYATI PLLC
Entity type:Organization
Organization Name:DR BAYATI PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:AL BAYATI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:602-315-9589
Mailing Address - Street 1:10601 PECAN PARK BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-1306
Mailing Address - Country:US
Mailing Address - Phone:512-580-9330
Mailing Address - Fax:
Practice Address - Street 1:10601 PECAN PARK BLVD STE 101
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1306
Practice Address - Country:US
Practice Address - Phone:512-580-9330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty