Provider Demographics
NPI:1609817956
Name:BAILEN, STEVEN D (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:D
Last Name:BAILEN
Suffix:
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 1:587 LOWELL ST
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-2331
Mailing Address - Country:US
Mailing Address - Phone:978-535-3162
Mailing Address - Fax:
Practice Address - Street 1:587 LOWELL ST
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2331
Practice Address - Country:US
Practice Address - Phone:978-535-3162
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA172011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice