Healthcare Provider Details

I. General information

NPI: 1285690305
Provider Name (Legal Business Name): MS. BERNICE BAILEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 05/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 LINN ST
CINCINNATI OH
45214-2605
US

IV. Provider business mailing address

1413 LINN ST
CINCINNATI OH
45214-2605
US

V. Phone/Fax

Practice location:
  • Phone: 513-621-2727
  • Fax:
Mailing address:
  • Phone: 513-621-2727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number31010845
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: