Provider Demographics
NPI:1306015540
Name:DR LISA BAILEY DDS, APDC
Entity Type:Organization
Organization Name:DR LISA BAILEY DDS, APDC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:C
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:225-644-4976
Mailing Address - Street 1:225 W ASCENSION ST
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-2803
Mailing Address - Country:US
Mailing Address - Phone:225-644-4976
Mailing Address - Fax:
Practice Address - Street 1:225 W ASCENSION ST
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-2803
Practice Address - Country:US
Practice Address - Phone:225-644-4976
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1881163292200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes292200000XLaboratoriesDental Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1235316217Medicaid
LA1023163599Medicaid