Provider Demographics
NPI:1114997657
Name:BAILEY, DANIEL KENT (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:KENT
Last Name:BAILEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2817 REILLY ST
Mailing Address - Street 2:MCDS NA B ATTN: DENTAC CREDENTIALS
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28310-7302
Mailing Address - Country:US
Mailing Address - Phone:910-396-5610
Mailing Address - Fax:910-396-7017
Practice Address - Street 1:2817 REILLY ST
Practice Address - Street 2:MCDS NA B ATTN: DENTAC CREDENTIALS
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-7302
Practice Address - Country:US
Practice Address - Phone:910-396-5610
Practice Address - Fax:910-396-7017
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC43141223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
BB6932859OtherFEDERAL DEA