Provider Demographics
NPI:1851664783
Name:JEFFREY S. BAILEY, DMD, PSC
Entity Type:Organization
Organization Name:JEFFREY S. BAILEY, DMD, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:D M D
Authorized Official - Phone:606-743-3200
Mailing Address - Street 1:629 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST LIBERTY
Mailing Address - State:KY
Mailing Address - Zip Code:41472-1017
Mailing Address - Country:US
Mailing Address - Phone:606-743-3200
Mailing Address - Fax:606-743-3201
Practice Address - Street 1:629 MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST LIBERTY
Practice Address - State:KY
Practice Address - Zip Code:41472-1017
Practice Address - Country:US
Practice Address - Phone:606-743-3200
Practice Address - Fax:606-743-3201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6336122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty