Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 4314 | NC |
NPI | 1114997657 |
---|---|
Provider Name | Dr. Daniel Kent Bailey |
First Address | Fort Bragg, NC 28310-7302 |
Second Address | Fort Bragg, NC 28310-7302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2006 |
Last Update Date | 28/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BB6932859 | FEDERAL DEA (01) |