Provider Demographics
NPI:1205177961
Name:BAILEY, ANNA E
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:E
Last Name:BAILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3349 NIAGARA FALLS BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-1213
Mailing Address - Country:US
Mailing Address - Phone:716-694-1777
Mailing Address - Fax:716-694-1888
Practice Address - Street 1:3349 NIAGARA FALLS BLVD
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-1213
Practice Address - Country:US
Practice Address - Phone:716-694-1777
Practice Address - Fax:716-694-1888
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-06
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY057493122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1205177961OtherNPI