Organization
FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TERRELL WAYNE BAILEY D.D.S. (OWNER)
(479) 394-5666
Entity
Organization
Contact information
Practice address
701 C 7TH STREET, MENA, AR 71953
(479) 394-5666
(479) 996-6536
Mailing address
701 C 7TH STREET, MENA, AR 71953
(479) 394-5666
(479) 996-6536
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2864
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
58213
BCBS FEDERAL
AR
01
—
610535
UNITED CONCORDIA
PA
01
—
884517
BCBS
AR
Enumeration date
04/12/2007
Last updated
08/04/2008
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