Provider Demographics
NPI:1386015741
Name:LTANYA JOY BAILEY ORTHODONTIST
Entity Type:Organization
Organization Name:LTANYA JOY BAILEY ORTHODONTIST
Other - Org Name:LTANYA JOY BAILEY DDS MS PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LTANYA
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-886-7000
Mailing Address - Street 1:2380 HICKSWOOD ROAD
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-1458
Mailing Address - Country:US
Mailing Address - Phone:336-886-7000
Mailing Address - Fax:336-886-7002
Practice Address - Street 1:2380 HICKSWOOD ROAD
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-1458
Practice Address - Country:US
Practice Address - Phone:336-886-7000
Practice Address - Fax:336-886-7002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-12
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1750711818Medicaid
NC1659493492Medicaid