Provider Demographics
NPI:1710190442
Name:BAILEY, THOMAS BURTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:BURTON
Last Name:BAILEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:TOM
Other - Middle Name:B
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:61 ROCKY VALLEY CV
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-3171
Mailing Address - Country:US
Mailing Address - Phone:501-954-9360
Mailing Address - Fax:
Practice Address - Street 1:201 WEST MAIN
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:AR
Practice Address - Zip Code:72650-3191
Practice Address - Country:US
Practice Address - Phone:870-448-3191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR19491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice