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General NPI Number Information
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NPI Number | 1295139582
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Entity Type | Organization
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Legal Business Name | BENJAMIN BAILEY DDS PC
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Dates
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Enumeration Date | 10/15/2014
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Last Update Date | 10/15/2014
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Provider Practice Location Address
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Address Line | 308 DARTMOUTH DR
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City | MIDLAND
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State | MI
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Zip | 48640-4524
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Country | US
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Telephone | 989-631-6075
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Fax | 989-631-3166
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Provider Business Mailing Address
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Address Line | 308 DARTMOUTH DR
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City | MIDLAND
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State | MI
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Zip | 48640-4524
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Country | US
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Telephone | 989-631-6075
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Fax | 989-631-3166
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BENJAMIN BAILEY
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Credential | DDS
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Telephone | 989-631-6075
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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 | 2901020193
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License Number State | MI
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