Provider Demographics
NPI:1215116108
Name:BAILEY, AARON MICHAEL (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:AARON
Middle Name:MICHAEL
Last Name:BAILEY
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1058 ASHER WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-6076
Mailing Address - Country:US
Mailing Address - Phone:903-509-4422
Mailing Address - Fax:903-509-4420
Practice Address - Street 1:1058 ASHER WAY STE 200
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-6076
Practice Address - Country:US
Practice Address - Phone:903-509-4422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX344991223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0128778Medicaid