Provider Demographics
NPI:1932387040
Name:BRIAN BAILEY DDS PC
Entity Type:Organization
Organization Name:BRIAN BAILEY DDS PC
Other - Org Name:BRIAN BAILEY DDS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:989-631-6075
Mailing Address - Street 1:308 DARTMOUTH DRIVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640
Mailing Address - Country:US
Mailing Address - Phone:989-631-6075
Mailing Address - Fax:989-631-3116
Practice Address - Street 1:308 DARTMOUTH DRIVE
Practice Address - Street 2:SUITE 1
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640
Practice Address - Country:US
Practice Address - Phone:989-631-6075
Practice Address - Fax:989-631-3116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901014377122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty