Healthcare Provider Details

I. General information

NPI: 1205764586
Provider Name (Legal Business Name): NOAH BAILEY DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6626 E BASELINE RD STE 101
MESA AZ
85206-4423
US

IV. Provider business mailing address

44 N 400 E
PROVO UT
84606-3213
US

V. Phone/Fax

Practice location:
  • Phone: 866-953-3272
  • Fax:
Mailing address:
  • Phone: 480-340-4181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1223G0001X
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: