Individual
RICHARD E. BAILEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
301 QUAIL RUN DR, MOSCOW, ID 83843-8205
(509) 336-8478
Mailing address
301 QUAIL RUN DR, MOSCOW, ID 83843-8205
(208) 336-8478
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D-3256
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806766401
—
ID
Enumeration date
05/07/2007
Last updated
01/04/2016
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