Provider Demographics
NPI:1942292339
Name:BAILEY, WELTMAN D (DDS)
Entity Type:Individual
Prefix:DR
First Name:WELTMAN
Middle Name:D
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 1:4301 PASEO BLVD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64110-1801
Mailing Address - Country:US
Mailing Address - Phone:816-924-1190
Mailing Address - Fax:816-924-0861
Practice Address - Street 1:4301 PASEO BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64110-1801
Practice Address - Country:US
Practice Address - Phone:816-924-1190
Practice Address - Fax:816-924-0861
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2008-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0102971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO400172300Medicaid