Provider Demographics
NPI:1518271873
Name:BAILEY, CHARLES WILLIAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:WILLIAM
Last Name:BAILEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:BILL
Other - Middle Name:
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:1025 FOOTE ST
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-4911
Mailing Address - Country:US
Mailing Address - Phone:662-287-3156
Mailing Address - Fax:
Practice Address - Street 1:1025 FOOTE ST
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-4911
Practice Address - Country:US
Practice Address - Phone:662-287-3156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3557-101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice