Provider Demographics
NPI:1417614652
Name:BAILEY, SANDRA GISELA (RDA)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:GISELA
Last Name:BAILEY
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4213 SHARWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-1654
Mailing Address - Country:US
Mailing Address - Phone:925-305-9795
Mailing Address - Fax:
Practice Address - Street 1:4213 SHARWOOD WAY
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-1654
Practice Address - Country:US
Practice Address - Phone:925-305-9795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDH27167124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist