Healthcare Provider Details

I. General information

NPI: 1558046995
Provider Name (Legal Business Name): BAILEY DUFFY DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2023
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

996 TANNER FORD BLVD
HANAHAN SC
29410-4780
US

IV. Provider business mailing address

996 TANNER FORD BLVD
HANAHAN SC
29410-4780
US

V. Phone/Fax

Practice location:
  • Phone: 843-818-5437
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number11206.PD
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: