Provider Demographics
NPI:1447269246
Name:BAILEY, SPENCER S (DDS, MSD)
Entity type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:S
Last Name:BAILEY
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14997 W BELL RD
Mailing Address - Street 2:STE. 150
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-3209
Mailing Address - Country:US
Mailing Address - Phone:623-977-0707
Mailing Address - Fax:623-977-1176
Practice Address - Street 1:14997 W BELL RD
Practice Address - Street 2:STE. 150
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-3209
Practice Address - Country:US
Practice Address - Phone:623-977-0707
Practice Address - Fax:623-977-1176
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD60961223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ01821553OtherUNITED CONCORDIA PROVIDER