1932387040 NPI number — BRIAN BAILEY DDS PC

Table of content: (NPI 1932387040)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932387040 NPI number — BRIAN BAILEY DDS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRIAN BAILEY DDS PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BRIAN BAILEY DDS
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932387040
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
308 DARTMOUTH DRIVE
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
MIDLAND
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48640
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-631-6075
Provider Business Mailing Address Fax Number:
989-631-3116

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
308 DARTMOUTH DRIVE
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
MIDLAND
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-631-6075
Provider Business Practice Location Address Fax Number:
989-631-3116
Provider Enumeration Date:
01/31/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BAILEY
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
989-631-6075

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  2901014377 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)