Provider Demographics
NPI:1477768729
Name:BAILEY, THOMAS AUGUST (DDS)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:AUGUST
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 1:539 HEAVENS DR
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-2833
Mailing Address - Country:US
Mailing Address - Phone:985-705-1420
Mailing Address - Fax:
Practice Address - Street 1:2301 N HIGHWAY 190
Practice Address - Street 2:SUITE #4
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-9061
Practice Address - Country:US
Practice Address - Phone:985-705-1420
Practice Address - Fax:985-809-9336
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA53841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice