Provider Demographics
NPI:1679819783
Name:LEIGH BAILEY WERNER DDS PC
Entity Type:Organization
Organization Name:LEIGH BAILEY WERNER DDS PC
Other - Org Name:EVANSDALE FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:BAILEY
Authorized Official - Last Name:WERNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:319-233-9903
Mailing Address - Street 1:3534 LAFAYETTE RD
Mailing Address - Street 2:
Mailing Address - City:EVANSDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50707-1025
Mailing Address - Country:US
Mailing Address - Phone:319-233-9903
Mailing Address - Fax:319-292-1696
Practice Address - Street 1:3534 LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:EVANSDALE
Practice Address - State:IA
Practice Address - Zip Code:50707-1025
Practice Address - Country:US
Practice Address - Phone:319-233-9903
Practice Address - Fax:319-292-1696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA08921261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental