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General NPI Number Information
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NPI Number | 1295528263
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Entity Type | Individual
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Provider Name | BAILEIGH NYCOLE MCKENZIE DMD
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Gender | Female
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Dates
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Enumeration Date | 05/23/2025
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Last Update Date | 05/23/2025
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Provider Practice Location Address
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Address Line | 71 WAYNE ST
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City | FORT GAY
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State | WV
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Zip | 25514-8518
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Country | US
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Telephone | 304-648-5544
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Fax |
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Provider Business Mailing Address
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Address Line | 71 WAYNE ST
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City | FORT GAY
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State | WV
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Zip | 25514-8518
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Country | US
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Telephone | 304-648-5544
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 4772
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License Number State | WV
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