Provider Demographics
NPI:1518108885
Name:LANCE D. BAILEY DDS PC
Entity Type:Organization
Organization Name:LANCE D. BAILEY DDS PC
Other - Org Name:DOWNTOWN DENTAL CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:D
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:503-228-4122
Mailing Address - Street 1:511 SW 10TH AVE
Mailing Address - Street 2:SUITE 1114
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2732
Mailing Address - Country:US
Mailing Address - Phone:503-228-4122
Mailing Address - Fax:503-228-2036
Practice Address - Street 1:511 SW 10TH AVE
Practice Address - Street 2:SUITE 1114
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2732
Practice Address - Country:US
Practice Address - Phone:503-228-4122
Practice Address - Fax:503-228-2036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD85781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty