Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist |
NPI | 1003265778 |
---|---|
Provider Name | Delacey Reid Bailey |
First Address | Fort Benning, GA 31905 |
Second Address | Fort Benning, GA 31905-3764 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2016 |
Last Update Date | 03/06/2016 |