Healthcare Provider Details

I. General information

NPI: 1841605722
Provider Name (Legal Business Name): WHITNEY BAILEY GWALTNEY DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: WHITNEY ANN BAILEY DDS

II. Dates (important events)

Enumeration Date: 06/30/2014
Last Update Date: 03/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2486 PRUDEN BLVD.
SUFFOLK VA
23434
US

IV. Provider business mailing address

2486 PRUDEN BLVD.
SUFFOLK VA
23434
US

V. Phone/Fax

Practice location:
  • Phone: 757-539-3021
  • Fax: 757-539-6262
Mailing address:
  • Phone: 757-539-3021
  • Fax: 757-539-6262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number150980
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401414957
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: