Healthcare Provider Details

I. General information

NPI: 1447257738
Provider Name (Legal Business Name): MARYANN K. BAILEY DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 W 4TH ST
WILMINGTON DE
19805-3420
US

IV. Provider business mailing address

1802 W 4TH ST
WILMINGTON DE
19805-3420
US

V. Phone/Fax

Practice location:
  • Phone: 302-655-5822
  • Fax: 302-655-5949
Mailing address:
  • Phone: 302-655-5822
  • Fax: 302-655-5949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberG1-0001163
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: