Provider Demographics
NPI:1437457884
Name:BAILEY, WARREN KELLEY (DMD)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:KELLEY
Last Name:BAILEY
Suffix:
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:PO BOX 43962
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-0962
Mailing Address - Country:US
Mailing Address - Phone:205-803-2131
Mailing Address - Fax:205-699-0424
Practice Address - Street 1:536 COBB ST
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6511
Practice Address - Country:US
Practice Address - Phone:205-803-2131
Practice Address - Fax:205-699-0424
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL42131223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery