Organization
EAST BAY ORAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHEN NICHOLAS BAKIAS DDS (OWNER)
(401) 435-4240
Entity
Organization
Contact information
Practice address
2224 PAWTUCKET AVENUE, EAST PROVIDENCE, RI 02914
(401) 435-4240
(401) 435-4245
Mailing address
2224 PAWTUCKET AVENUE, EAST PROVIDENCE, RI 02914
(401) 435-4240
(401) 435-4245
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
1686
RI
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
16987
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
80301
BLUE CROSS
RI
01
—
X11644
BLUE CROSS
MA
Enumeration date
05/03/2006
Last updated
04/20/2008
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