Provider Demographics
NPI:1457472862
Name:BAILEY, MALCOLM DOUGLAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:MALCOLM
Middle Name:DOUGLAS
Last Name:BAILEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 LEE DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-1909
Mailing Address - Country:US
Mailing Address - Phone:662-627-4791
Mailing Address - Fax:662-627-4791
Practice Address - Street 1:130 LEE DR
Practice Address - Street 2:
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-1909
Practice Address - Country:US
Practice Address - Phone:662-627-4791
Practice Address - Fax:662-627-4791
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1657751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice