Provider Demographics
NPI:1306945159
Name:R. MARK BAILEY,D.D.S.,P.A.
Entity type:Organization
Organization Name:R. MARK BAILEY,D.D.S.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBBINS
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-637-2735
Mailing Address - Street 1:2114 RICE STREET
Mailing Address - Street 2:P.O. BOX 907
Mailing Address - City:WALDRON
Mailing Address - State:AR
Mailing Address - Zip Code:72958-0907
Mailing Address - Country:US
Mailing Address - Phone:479-637-2735
Mailing Address - Fax:479-637-5091
Practice Address - Street 1:2114 RICE STREET
Practice Address - Street 2:
Practice Address - City:WALDRON
Practice Address - State:AR
Practice Address - Zip Code:72958-0907
Practice Address - Country:US
Practice Address - Phone:479-637-2735
Practice Address - Fax:479-637-5091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR26251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty