Gregorio Wayne Bautista, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN13033 Issued in FL

Practice address

909 E Oak St Ste a
Kissimmee, FL 34744

Phone

(407) 847-2103

Fax

(407) 847-5042

NPI assigned

Dec 31, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• G Wayne Bautista Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1199059200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1699950329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4719 LEGACY OAKS DR",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328392067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 E OAK ST STE A",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "34744",
            "telephone_number": "407-847-2103",
            "fax_number": "407-847-5042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAUTISTA",
        "first_name": "GREGORIO",
        "middle_name": "WAYNE",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-12-31",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN13033",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "017646700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "G",
            "last_name": "BAUTISTA",
            "middle_name": "WAYNE",
            "credential": "DMD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Hakeem O. Bastien
• Kayla Batista, MD
• Yomar Batlle
• Genesis Carolina Battah, RBT
• Emma Bautista Ocampo, MD
• Valeria Maria Bautista, BT
• Fatima Bawaney
• Tabitha Baxter, PTA
• Cristina Bayardelle, CAA
• Ashlee Bayon

• General Practice Dentistry in Kissimmee, FL
• Providers in Kissimmee, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.