1750287405 NPI number — DR. RICHARD LYLE BAILEY II D.D.S.

Table of content: DR. RICHARD LYLE BAILEY II D.D.S. (NPI 1750287405)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750287405 NPI number — DR. RICHARD LYLE BAILEY II D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAILEY
Provider First Name:
RICHARD
Provider Middle Name:
LYLE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
II
Provider Credential Text:
D.D.S.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BAILEY
Provider Other First Name:
RICHARD
Provider Other Middle Name:
LYLE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.D.S.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1750287405
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/19/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
557 COTTONWOOD AVENUE, SUITE #100
Provider Second Line Business Mailing Address:
SUITE #100
Provider Business Mailing Address City Name:
HARTLAND
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53029-2347
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-369-8633
Provider Business Mailing Address Fax Number:
262-369-1789

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
557 COTTONWOOD AVE
Provider Second Line Business Practice Location Address:
SUITE #100
Provider Business Practice Location Address City Name:
HARTLAND
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53029-2347
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-369-8633
Provider Business Practice Location Address Fax Number:
262-369-1789
Provider Enumeration Date:
10/19/2026

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  4478-15 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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