Provider Demographics
NPI:1538284260
Name:BAILEY, JEFFREY SCOTT (DMD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:SCOTT
Last Name:BAILEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WEST LIBERTY
Mailing Address - State:KY
Mailing Address - Zip Code:41472
Mailing Address - Country:US
Mailing Address - Phone:606-743-3200
Mailing Address - Fax:606-743-3201
Practice Address - Street 1:629 MAIN STREET
Practice Address - Street 2:
Practice Address - City:WEST LIBERTY
Practice Address - State:KY
Practice Address - Zip Code:41472
Practice Address - Country:US
Practice Address - Phone:606-743-3200
Practice Address - Fax:606-743-3201
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6336122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60063369Medicaid