Individual provider Active NPI

Marshall Scott Bailey, D.M.D.

  • General Practice Dentistry
  • Saint Augustine, FL
National Provider Identifier
1710077078
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
15534 Issued in FL
Practice address
75 San Marco Ave
Saint Augustine, FL 32084-3257
Phone
(904) 810-1002
Fax
(904) 823-9784
NPI assigned
Oct 14, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 15534 FL Primary

Addresses

Primary practice location

75 San Marco Ave
Saint Augustine, FL 32084-3257

Mailing address

75 San Marco Ave
Saint Augustine, FL 32084-3257
Phone (904) 810-1002

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
15534FLMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Harbour Dental Care, P.a. PastSince Dec 9, 2019 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1710077078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 SAN MARCO AVE",
            "city": "SAINT AUGUSTINE",
            "state": "FL",
            "postal_code": "320843257",
            "telephone_number": "904-810-1002",
            "fax_number": "904-823-9784"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 SAN MARCO AVE",
            "city": "SAINT AUGUSTINE",
            "state": "FL",
            "postal_code": "320843257",
            "telephone_number": "904-810-1002",
            "fax_number": "904-823-9784"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAILEY",
        "first_name": "MARSHALL",
        "middle_name": "SCOTT",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "15534",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Augustine, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.