Provider Demographics
NPI:1285990978
Name:BAILEY, SAMUEL BLACKHAM (DMD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:BLACKHAM
Last Name:BAILEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 LAKE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-9655
Mailing Address - Country:US
Mailing Address - Phone:801-259-6988
Mailing Address - Fax:
Practice Address - Street 1:2964 W 4700 S STE 103
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84129-2558
Practice Address - Country:US
Practice Address - Phone:801-417-8080
Practice Address - Fax:801-417-8090
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-06
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7693653-99221223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry