Provider Demographics
NPI:1265732226
Name:BAILEY, GRAYLON W (DMD)
Entity type:Individual
Prefix:DR
First Name:GRAYLON
Middle Name:W
Last Name:BAILEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 NC HIGHWAY 125
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPID
Mailing Address - State:NC
Mailing Address - Zip Code:27870-6447
Mailing Address - Country:US
Mailing Address - Phone:252-533-9300
Mailing Address - Fax:
Practice Address - Street 1:523 NC HIGHWAY 125
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPID
Practice Address - State:NC
Practice Address - Zip Code:27870-6447
Practice Address - Country:US
Practice Address - Phone:252-533-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014130031223G0001X
NC90891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice