Provider Demographics
NPI:1689993230
Name:BAILEY, BENJAMIN LEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:LEN
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 1:308 DARTMOUTH DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-4524
Mailing Address - Country:US
Mailing Address - Phone:989-631-6075
Mailing Address - Fax:989-631-3116
Practice Address - Street 1:308 DARTMOUTH DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-4524
Practice Address - Country:US
Practice Address - Phone:989-631-6075
Practice Address - Fax:989-631-3116
Is Sole Proprietor?:No
Enumeration Date:2010-05-21
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901020193122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist