Provider Demographics
NPI:1932432770
Name:BAILEY, JOHN RYAN (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RYAN
Last Name:BAILEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:RYAN
Other - Middle Name:J
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:10705 COURTHOUSE RD STE 118
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-7797
Mailing Address - Country:US
Mailing Address - Phone:540-369-4939
Mailing Address - Fax:
Practice Address - Street 1:10705 COURTHOUSE RD STE 118
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-7797
Practice Address - Country:US
Practice Address - Phone:540-369-4939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD93461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice