Provider Demographics
NPI:1578589586
Name:BAILEY, TOBIN LEE SR (DDS)
Entity Type:Individual
Prefix:DR
First Name:TOBIN
Middle Name:LEE
Last Name:BAILEY
Suffix:SR
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 1:2243 E APPLE AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-4391
Mailing Address - Country:US
Mailing Address - Phone:231-773-8110
Mailing Address - Fax:231-773-6367
Practice Address - Street 1:2243 E APPLE AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-4391
Practice Address - Country:US
Practice Address - Phone:231-773-8110
Practice Address - Fax:231-773-6367
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MID0921001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4013384Medicaid