Provider Demographics
NPI:1518015114
Name:L'TANYA J. BAILEY, D.D.S, MS, PLLC
Entity type:Organization
Organization Name:L'TANYA J. BAILEY, D.D.S, MS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:L'TANYA
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS, PLLC
Authorized Official - Phone:336-886-7000
Mailing Address - Street 1:PO BOX 6074
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-6074
Mailing Address - Country:US
Mailing Address - Phone:336-886-7000
Mailing Address - Fax:336-886-7002
Practice Address - Street 1:6425 OLD PLANK RD
Practice Address - Street 2:SUITE 108
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-3277
Practice Address - Country:US
Practice Address - Phone:336-886-7000
Practice Address - Fax:336-886-7002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC51991223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8990332Medicaid