Provider Demographics
NPI:1316011000
Name:BAILEY, RANDALL SCOTT SR (DMD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:SCOTT
Last Name:BAILEY
Suffix:SR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 NIGHTINGALE LN
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32561-4337
Mailing Address - Country:US
Mailing Address - Phone:850-934-3408
Mailing Address - Fax:850-934-3832
Practice Address - Street 1:85 NIGHTINGALE LN
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32561-4337
Practice Address - Country:US
Practice Address - Phone:850-934-3408
Practice Address - Fax:850-934-3832
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL99711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice