Provider Demographics
NPI:1700164084
Name:ROBERT A BAILEY DDS PA
Entity Type:Organization
Organization Name:ROBERT A BAILEY DDS PA
Other - Org Name:ACCESS FAMILY DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-624-3611
Mailing Address - Street 1:108 POLYANTHUS PL
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-7582
Mailing Address - Country:US
Mailing Address - Phone:919-762-9194
Mailing Address - Fax:919-794-7211
Practice Address - Street 1:1006 LAMOND AVE STE C
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-2074
Practice Address - Country:US
Practice Address - Phone:919-794-7210
Practice Address - Fax:919-794-7211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-03
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7755122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5903523Medicaid
NC1760543599OtherNPI