Provider Demographics
NPI:1467512079
Name:BAILEY, TERRELL WAYNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:TERRELL
Middle Name:WAYNE
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 1:701 C 7TH STREET
Mailing Address - Street 2:
Mailing Address - City:MENA
Mailing Address - State:AR
Mailing Address - Zip Code:71953
Mailing Address - Country:US
Mailing Address - Phone:479-394-5666
Mailing Address - Fax:479-996-6536
Practice Address - Street 1:520 HAMILTON LANE
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:AR
Practice Address - Zip Code:72936
Practice Address - Country:US
Practice Address - Phone:479-996-6555
Practice Address - Fax:479-996-6536
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2864122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA884517OtherUNITED CONCORDIA
AR58213OtherBCBS FEDERAL