Provider Demographics
NPI:1619541497
Name:BAILEY, ALANDRAH NICHOLE
Entity Type:Individual
Prefix:
First Name:ALANDRAH
Middle Name:NICHOLE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 DE MOSS ST
Mailing Address - Street 2:
Mailing Address - City:LORDSBURG
Mailing Address - State:NM
Mailing Address - Zip Code:88045-2617
Mailing Address - Country:US
Mailing Address - Phone:575-542-2369
Mailing Address - Fax:575-542-2388
Practice Address - Street 1:1007 N POPE ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-5161
Practice Address - Country:US
Practice Address - Phone:575-388-1511
Practice Address - Fax:575-313-8236
Is Sole Proprietor?:No
Enumeration Date:2021-05-17
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD5463122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist