Healthcare Provider Details

I. General information

NPI: 1225132871
Provider Name (Legal Business Name): BRENT G BAILEY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 05/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 21ST AVE
ISLE OF PALMS SC
29451-2384
US

IV. Provider business mailing address

15 21ST AVE
ISLE OF PALMS SC
29451-2384
US

V. Phone/Fax

Practice location:
  • Phone: 843-886-6461
  • Fax: 846-886-3957
Mailing address:
  • Phone: 843-886-6461
  • Fax: 843-886-3957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3539
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: