Provider Demographics
NPI:1912915810
Name:BAYLIFF, JERRY GREEN JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:GREEN
Last Name:BAYLIFF
Suffix:JR
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 1:441 S MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:ROXBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27573-5123
Mailing Address - Country:US
Mailing Address - Phone:336-599-6640
Mailing Address - Fax:336-599-7182
Practice Address - Street 1:441 S MORGAN ST
Practice Address - Street 2:
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27573-5123
Practice Address - Country:US
Practice Address - Phone:336-599-6640
Practice Address - Fax:336-599-7182
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6119122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist