Healthcare Provider Details

I. General information

NPI: 1669461927
Provider Name (Legal Business Name): ANTHONY DAVID BAILEY D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 W MAIN ST
BEDFORD VA
24523-1950
US

IV. Provider business mailing address

167 W MAIN ST
BEDFORD VA
24523-1950
US

V. Phone/Fax

Practice location:
  • Phone: 540-586-8106
  • Fax: 540-586-5054
Mailing address:
  • Phone: 540-586-8106
  • Fax: 540-586-5054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number05448
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: