Provider Demographics
NPI:1689916611
Name:BAILEY, BEN ADAM CHARLES (DMD)
Entity Type:Individual
Prefix:DR
First Name:BEN ADAM
Middle Name:CHARLES
Last Name:BAILEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3691 PARKER BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-2278
Mailing Address - Country:US
Mailing Address - Phone:719-212-0777
Mailing Address - Fax:
Practice Address - Street 1:3691 PARKER BLVD STE 200
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-2278
Practice Address - Country:US
Practice Address - Phone:719-212-0777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00203311204E00000X
WADR603607051223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery