Provider Demographics
NPI:1912980640
Name:BAILEY, JENNIFER LEA (DDS)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LEA
Last Name:BAILEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:LEA
Other - Last Name:GRANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:67 N DOBSON RD STE A-104
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-6822
Mailing Address - Country:US
Mailing Address - Phone:888-785-2336
Mailing Address - Fax:
Practice Address - Street 1:78 N COOPER RD STE 107
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-5210
Practice Address - Country:US
Practice Address - Phone:480-964-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA08118122300000X
SC4161122300000X
AZ81151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist