Provider Demographics
NPI:1477577393
Name:BAILEY, BRYAN F (DDS)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:F
Last Name:BAILEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4905 LEXINGTON SQ
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-6574
Mailing Address - Country:US
Mailing Address - Phone:806-367-9990
Mailing Address - Fax:806-367-9945
Practice Address - Street 1:4905 LEXINGTON SQ
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-6574
Practice Address - Country:US
Practice Address - Phone:806-367-9990
Practice Address - Fax:806-367-9945
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS600491223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100289290AMedicaid
KS650745Medicare ID - Type Unspecified
KS100289290AMedicaid