| East Bay Oral Surgery | |
|
2224 Pawtucket Avenue East Providence RI 02914 | |
| (401) 435-4240 | |
| (401) 435-4245 |
| Full Name | East Bay Oral Surgery |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 2224 Pawtucket Avenue, East Providence, Rhode Island |
| Authorized Official Name and Position | Stephen Nicholas Bakias (OWNER) |
| Authorized Official Contact | 4014354240 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| East Bay Oral Surgery 2224 Pawtucket Avenue East Providence RI 02914 Ph: (401) 435-4240 | East Bay Oral Surgery 2224 Pawtucket Avenue East Providence RI 02914 Ph: (401) 435-4240 |
| NPI Number | 1285692731 |
|---|---|
| Provider Enumeration Date | 05/03/2006 |
| Last Update Date | 04/20/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285692731 | NPI | - | NPPES |
| X11644 | Other | MA | BLUE CROSS |
| 80301 | Other | RI | BLUE CROSS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 16987 (Massachusetts) | Secondary |
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 1686 (Rhode Island) | Primary |
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