Provider Demographics
NPI:1811738826
Name:WATHEN, BAILEE BROOKE (DMD)
Entity type:Individual
Prefix:
First Name:BAILEE
Middle Name:BROOKE
Last Name:WATHEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22934 MOUNTAIN LAUREL LN
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA
Mailing Address - State:MD
Mailing Address - Zip Code:20619-7164
Mailing Address - Country:US
Mailing Address - Phone:301-481-4206
Mailing Address - Fax:
Practice Address - Street 1:23140 MOAKLEY ST STE 5
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-2931
Practice Address - Country:US
Practice Address - Phone:301-475-2881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-04
Last Update Date:2025-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0446571223G0001X
MD186091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice