Provider Demographics
NPI:1942419031
Name:BAILEY, JOHN R (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:BAILEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2000C N GAINES DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CLINTON
Mailing Address - State:MO
Mailing Address - Zip Code:64735-1132
Mailing Address - Country:US
Mailing Address - Phone:660-885-3391
Mailing Address - Fax:660-885-6617
Practice Address - Street 1:2000C N GAINES DR
Practice Address - Street 2:SUITE 3
Practice Address - City:CLINTON
Practice Address - State:MO
Practice Address - Zip Code:64735-1132
Practice Address - Country:US
Practice Address - Phone:660-885-3391
Practice Address - Fax:660-885-6617
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO12060122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist