Provider Demographics
NPI:1184112070
Name:JASON MICHAEL BAILEY DMD PC
Entity type:Organization
Organization Name:JASON MICHAEL BAILEY DMD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:251-225-8838
Mailing Address - Street 1:8158 STATE HIGHWAY 59 APT 105
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-3881
Mailing Address - Country:US
Mailing Address - Phone:251-225-8838
Mailing Address - Fax:
Practice Address - Street 1:8158 STATE HIGHWAY 59 APT 105
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-3881
Practice Address - Country:US
Practice Address - Phone:251-225-8838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAILEY ORTHODONTICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL51231223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty