MEDICARE: DR. JADEN DEAN BAILEY D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	60992	KS

General Provider Information

NPI Number	:	1801234984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JADEN DEAN BAILEY D.D.S.

Provider Business Mailing Address
First Line	:	4627 SHAWNEE DR
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66106-3648
Country	:	US
Telephone Number	:	913-677-1004
Fax Number	:	913-677-2820

Provider Business Practice Location Address
First Line	:	4627 SHAWNEE DR
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66106-3648
Country	:	US
Telephone Number	:	913-677-1004
Fax Number	:	913-677-2820

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2013
Last Update Date	:	06/11/2013

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