Healthcare Provider Details

I. General information

NPI: 1871505479
Provider Name (Legal Business Name): RANDALL BRENT BAILEY D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 E MEDICAL CENTER BLVD
WEBSTER TX
77598-4326
US

IV. Provider business mailing address

3811 ALMOND CREEK DR
HOUSTON TX
77059-3703
US

V. Phone/Fax

Practice location:
  • Phone: 281-461-1982
  • Fax: 281-461-0261
Mailing address:
  • Phone: 281-286-2817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number13832
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: