Provider Demographics
NPI:1215500590
Name:PROFT, BAILEY ZAUN (DMD)
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:ZAUN
Last Name:PROFT
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 1:4022 OAK RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77009-5231
Mailing Address - Country:US
Mailing Address - Phone:860-977-6185
Mailing Address - Fax:
Practice Address - Street 1:2830 COMMERCIAL CENTER BLVD STE 101
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-6406
Practice Address - Country:US
Practice Address - Phone:281-693-1333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX374801223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics