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NPI Code Detail

MEDICARE: DR. JOHN R BAILEY D.D.S.

MEDICARE: DR. JOHN R BAILEY D.D.S.
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
1122300000XDentist12060MO

General Provider Information

NPI Number : 1942419031
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN R BAILEY D.D.S.
Provider Business Mailing Address
First Line : 2000C N GAINES DR
Second Line : SUITE 3
City : CLINTON
State : MO
Zip : 64735-1132
Country : US
Telephone Number : 660-885-3391
Fax Number : 660-885-6617
Provider Business Practice Location Address
First Line : 2000C N GAINES DR
Second Line : SUITE 3
City : CLINTON
State : MO
Zip : 64735-1132
Country : US
Telephone Number : 660-885-3391
Fax Number : 660-885-6617
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2007
Last Update Date : 07/08/2007

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