Healthcare Provider Details

I. General information

NPI: 1407957723
Provider Name (Legal Business Name): JAMES IVAN BAILEY D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 N CEDAR HILLS DR
PRICE UT
84501-2746
US

IV. Provider business mailing address

230 N CEDAR HILLS DR
PRICE UT
84501-2746
US

V. Phone/Fax

Practice location:
  • Phone: 435-637-3186
  • Fax: 435-637-3838
Mailing address:
  • Phone: 435-637-3186
  • Fax: 435-637-3838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number135569-9922
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: