Provider Demographics
NPI:1770696809
Name:BAILEY, BRENT MERVIN (DMD)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:MERVIN
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 1:2285 KITTANNING PIKE
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:PA
Mailing Address - Zip Code:16049-1411
Mailing Address - Country:US
Mailing Address - Phone:724-399-9195
Mailing Address - Fax:724-399-9199
Practice Address - Street 1:2285 KITTANNING PIKE
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:PA
Practice Address - Zip Code:16049-1411
Practice Address - Country:US
Practice Address - Phone:724-399-9195
Practice Address - Fax:724-399-9199
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030697L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
01336244OtherUCCI