Individual
DR. LANCE DON BAILEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1511 LAKEVIEW WAY, OGDEN, UT 84403
(801) 200-2516
(503) 228-2036
Mailing address
1511 LAKEVIEW WAY, OGDEN, UT 84403
(801) 200-2516
(503) 228-2036
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
337850
UT
122300000X
Dentist
D8578
OR
1223G0001X
General Practice Dentistry
D8578
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1268944-1
BUSINESS IDENFICATOIN
OR
01
—
20-3988434
EMPLOYER IDENTIFICATION
OR
01
—
D8578
STATE LICENSE
OR
Enumeration date
08/21/2006
Last updated
02/24/2020
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