Provider Demographics
NPI:1093721920
Name:BAILEY, JEFFREY CHARLES (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:CHARLES
Last Name:BAILEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9191 CHILLICOTHE RD
Mailing Address - Street 2:
Mailing Address - City:KIRTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44094-9263
Mailing Address - Country:US
Mailing Address - Phone:440-256-8150
Mailing Address - Fax:440-256-1025
Practice Address - Street 1:9191 CHILLICOTHE RD
Practice Address - Street 2:
Practice Address - City:KIRTLAND
Practice Address - State:OH
Practice Address - Zip Code:44094-9263
Practice Address - Country:US
Practice Address - Phone:440-256-8150
Practice Address - Fax:440-256-1025
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH187211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice