Healthcare Provider Details

I. General information

NPI: 1760113328
Provider Name (Legal Business Name): BAILEY NEVILLE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2022
Last Update Date: 06/23/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 DODGE ST
OMAHA NE
68114-4113
US

IV. Provider business mailing address

3015 S 144TH AVE
OMAHA NE
68144-3271
US

V. Phone/Fax

Practice location:
  • Phone: 402-559-6100
  • Fax:
Mailing address:
  • Phone: 402-853-1771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7842
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: