Provider Demographics
NPI:1538224811
Name:BAILEY, LAWRENCE (DDS)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:
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 1:264 W 118TH ST
Mailing Address - Street 2:SECOND FLOOR DENTAL CLINIC
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-1620
Mailing Address - Country:US
Mailing Address - Phone:212-932-6596
Mailing Address - Fax:212-932-6599
Practice Address - Street 1:264 W 118TH ST
Practice Address - Street 2:SECOND FLOOR DENTAL CLINIC
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-1620
Practice Address - Country:US
Practice Address - Phone:212-932-6596
Practice Address - Fax:212-932-6599
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037092-11223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health