MEDICARE: JEANNE KAYE BAILEY DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2682	WV

General Provider Information

NPI Number	:	1629097241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANNE KAYE BAILEY DDS

Provider Business Mailing Address
First Line	:	1401 HOSPITAL DR
Second Line	:
City	:	HURRICANE
State	:	WV
Zip	:	25526-9237
Country	:	US
Telephone Number	:	304-757-7428
Fax Number	:	304-757-3535

Provider Business Practice Location Address
First Line	:	1401 HOSPITAL DR
Second Line	:
City	:	HURRICANE
State	:	WV
Zip	:	25526-9237
Country	:	US
Telephone Number	:	304-757-7428
Fax Number	:	304-757-3535

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	07/08/2007

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