Provider Demographics
NPI:1639388846
Name:BAILEY, KEVIN HEATH (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:HEATH
Last Name:BAILEY
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 1:411 CARRIAGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801
Mailing Address - Country:US
Mailing Address - Phone:304-252-4897
Mailing Address - Fax:304-252-2892
Practice Address - Street 1:411 CARRIAGE DRIVE
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801
Practice Address - Country:US
Practice Address - Phone:304-252-4897
Practice Address - Fax:304-252-2892
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3399122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist