Provider Demographics
NPI:1376800508
Name:LANCE DON BAILEY
Entity Type:Organization
Organization Name:LANCE DON BAILEY
Other - Org Name:DOWNTOWN DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:DON
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:503-786-3000
Mailing Address - Street 1:10001 SE SUNNYSIDE RD STE 250
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-9748
Mailing Address - Country:US
Mailing Address - Phone:503-786-3000
Mailing Address - Fax:
Practice Address - Street 1:10001 SE SUNNYSIDE RD STE 250
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-9748
Practice Address - Country:US
Practice Address - Phone:503-786-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD85781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty