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General NPI Number Information
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NPI Number | 1174812689
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Entity Type | Organization
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Legal Business Name | ZACHARY J BAILEY DDS INC
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Dates
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Enumeration Date | 04/05/2011
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Last Update Date | 04/05/2011
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Provider Practice Location Address
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Address Line | 515 6TH ST NE
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City | STAPLES
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State | MN
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Zip | 56479
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Country | US
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Telephone | 218-894-1941
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Fax | 218-894-5729
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Provider Business Mailing Address
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Address Line | 515 6TH ST NE
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City | STAPLES
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State | MN
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Zip | 56479
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Country | US
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Telephone | 218-894-1941
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Fax | 218-894-5729
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Authorized Official
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Title or Position | OFFICER
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Name | ZACHARY J BAILEY
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Credential | DDS
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Telephone | 218-894-1941
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D11468
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License Number State | MN
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