Provider Demographics
NPI:1912361924
Name:PERRICONE, BAILEY MARIE (RDH)
Entity Type:Individual
Prefix:MRS
First Name:BAILEY
Middle Name:MARIE
Last Name:PERRICONE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 KIVA RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80911-1913
Mailing Address - Country:US
Mailing Address - Phone:719-392-5300
Mailing Address - Fax:719-392-1093
Practice Address - Street 1:513 KIVA RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80911-1913
Practice Address - Country:US
Practice Address - Phone:719-392-5300
Practice Address - Fax:719-392-1093
Is Sole Proprietor?:No
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO000906094124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist