Provider Demographics
NPI:1568549038
Name:ROSE HARUKO BAILEY DDS PLLC
Entity Type:Organization
Organization Name:ROSE HARUKO BAILEY DDS PLLC
Other - Org Name:ROSE H. BAILEY, DDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:H
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-352-9391
Mailing Address - Street 1:911 5TH AVE SE STE 101
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-1505
Mailing Address - Country:US
Mailing Address - Phone:360-352-9391
Mailing Address - Fax:360-753-6164
Practice Address - Street 1:911 5TH AVE SE STE 101
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-1505
Practice Address - Country:US
Practice Address - Phone:360-352-9391
Practice Address - Fax:360-753-6164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA77161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty