Healthcare Provider Details

I. General information

NPI: 1669004255
Provider Name (Legal Business Name): BAILEE NICOLE DENT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2020
Last Update Date: 11/27/2023
Certification Date: 02/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 HOPE RD STE 215
STAFFORD VA
22554-7287
US

IV. Provider business mailing address

401 COBBLESTONE DR APT 208
FREDERICKSBURG VA
22401-6664
US

V. Phone/Fax

Practice location:
  • Phone: 866-311-4617
  • Fax:
Mailing address:
  • Phone: 434-430-0616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: