Provider Demographics
NPI:1659493492
Name:BAILEY, L'TANYA JOY (DDS, MS, PLLC)
Entity Type:Individual
Prefix:DR
First Name:L'TANYA
Middle Name:JOY
Last Name:BAILEY
Suffix:
Gender:F
Credentials:DDS, MS, PLLC
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Other - First Name:
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Mailing Address - Street 1:6425 OLD PLANK RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-3277
Mailing Address - Country:US
Mailing Address - Phone:336-886-7000
Mailing Address - Fax:336-886-7002
Practice Address - Street 1:6425 OLD PLANK RD
Practice Address - Street 2:SUITE 108
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-3277
Practice Address - Country:US
Practice Address - Phone:336-886-7000
Practice Address - Fax:336-886-7002
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC51991223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8990332Medicaid