Provider Demographics
NPI:1396579033
Name:BAILEY, LACEY ANDREA (DDS)
Entity type:Individual
Prefix:DR
First Name:LACEY
Middle Name:ANDREA
Last Name:BAILEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4226 DONEGAL RD
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-2833
Mailing Address - Country:US
Mailing Address - Phone:316-648-9449
Mailing Address - Fax:
Practice Address - Street 1:5710 ROCKFISH RD
Practice Address - Street 2:
Practice Address - City:HOPE MILLS
Practice Address - State:NC
Practice Address - Zip Code:28348-1847
Practice Address - Country:US
Practice Address - Phone:910-424-3623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13955122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist