Provider Demographics
NPI:1093201253
Name:BAILEY DENTAL,PLLC
Entity Type:Organization
Organization Name:BAILEY DENTAL,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAMILLE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:MEGNA-ACORLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:716-838-6633
Mailing Address - Street 1:2866 BAILEY AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-2802
Mailing Address - Country:US
Mailing Address - Phone:716-838-6633
Mailing Address - Fax:716-862-0096
Practice Address - Street 1:2866 BAILEY AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-2802
Practice Address - Country:US
Practice Address - Phone:716-838-6633
Practice Address - Fax:716-862-0096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04665289Medicaid