Provider Demographics
NPI:1801042718
Name:RODNEY L BAILEY, DMD, PC
Entity type:Organization
Organization Name:RODNEY L BAILEY, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-288-6262
Mailing Address - Street 1:2246 S STATE ROUTE 157
Mailing Address - Street 2:SUITE 125
Mailing Address - City:GLEN CARBON
Mailing Address - State:IL
Mailing Address - Zip Code:62034-1717
Mailing Address - Country:US
Mailing Address - Phone:618-288-6262
Mailing Address - Fax:
Practice Address - Street 1:2246 S STATE ROUTE 157
Practice Address - Street 2:SUITE 125
Practice Address - City:GLEN CARBON
Practice Address - State:IL
Practice Address - Zip Code:62034-1717
Practice Address - Country:US
Practice Address - Phone:618-288-6262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty