Healthcare Provider Details

I. General information

NPI: 1386015741
Provider Name (Legal Business Name): LTANYA JOY BAILEY ORTHODONTIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2015
Last Update Date: 10/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2380 HICKSWOOD ROAD
HIGH POINT NC
27265-1458
US

IV. Provider business mailing address

2380 HICKSWOOD ROAD
HIGH POINT NC
27265-1458
US

V. Phone/Fax

Practice location:
  • Phone: 336-886-7000
  • Fax: 336-886-7002
Mailing address:
  • Phone: 336-886-7000
  • Fax: 336-886-7002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. LTANYA JOY BAILEY
Title or Position: OWNER
Credential: D.D.S.
Phone: 336-886-7000