Provider Demographics
NPI:1306197983
Name:BAGLEY, ANDREW JOSHUA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JOSHUA
Last Name:BAGLEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-5808
Mailing Address - Country:US
Mailing Address - Phone:970-353-3664
Mailing Address - Fax:970-392-0922
Practice Address - Street 1:913 27TH AVE
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-5808
Practice Address - Country:US
Practice Address - Phone:970-353-3664
Practice Address - Fax:970-392-0922
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10732122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist