Provider Demographics
NPI:1568507887
Name:BAYLESS, JEANNE HANSEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:HANSEN
Last Name:BAYLESS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 BELTWAY NO.
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601
Mailing Address - Country:US
Mailing Address - Phone:325-672-5988
Mailing Address - Fax:325-672-5988
Practice Address - Street 1:1034 N WILLIS ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79603-4622
Practice Address - Country:US
Practice Address - Phone:325-673-8164
Practice Address - Fax:325-673-0812
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0095853-01Medicaid
TX1568507887Medicaid