MEDICARE: DR. MARY BAILEY DMD

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	122300000X	Dentist	019030849	IL

General Provider Information

NPI Number	:	1700339173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY BAILEY DMD

Provider Business Mailing Address
First Line	:	5160 S PULASKI RD STE 102
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60632-4253
Country	:	US
Telephone Number	:	773-423-2810
Fax Number	:

Provider Business Practice Location Address
First Line	:	5160 S PULASKI RD
Second Line	:	SUITE 102
City	:	CHICAGO
State	:	IL
Zip	:	60632-4253
Country	:	US
Telephone Number	:	773-423-2810
Fax Number	:

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

Provider Enumeration Date	:	08/02/2016
Last Update Date	:	12/28/2021

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