Provider Demographics
NPI:1710122809
Name:BAILEY, TERESE HONEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:TERESE
Middle Name:HONEL
Last Name:BAILEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:557 COTTONWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53029-2347
Mailing Address - Country:US
Mailing Address - Phone:262-369-8633
Mailing Address - Fax:262-369-1789
Practice Address - Street 1:557 COTTONWOOD AVE
Practice Address - Street 2:
Practice Address - City:HARTLAND
Practice Address - State:WI
Practice Address - Zip Code:53029-2347
Practice Address - Country:US
Practice Address - Phone:262-369-8633
Practice Address - Fax:262-369-1789
Is Sole Proprietor?:No
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4483-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice