Kenton Lee Bailey, D.D.S.
Individual provider Active NPI Dentist · Monroeville, IN
NPI 1376508689 · NPPES record last updated Apr 9, 2013
Key facts
- NPI
- 1376508689
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 12009002A (IN)
- Practice address
- 506 W South St
Monroeville, IN 46773-9592 - Phone
- (260) 623-6171
- NPI assigned
- Apr 19, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180626003639 | IN | Order and Referring Only - Dentist |
0042453193 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12009002A | IN | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 12009002A | IN | Yes |
Addresses
Primary practice location
506 W South St
Monroeville, IN 46773-9592
Mailing address
506 W South St
PO Box 419
Monroeville, IN 46773-9592
Phone (260) 623-6171
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100082140A | Medicaid | IN |
Other providers in Monroeville, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 9, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.