Provider Demographics
NPI:1578628459
Name:BAILEY, ROSANNA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROSANNA
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15908 CRAIN HWY UNIT D
Mailing Address - Street 2:
Mailing Address - City:BRANDYWINE
Mailing Address - State:MD
Mailing Address - Zip Code:20613-8032
Mailing Address - Country:US
Mailing Address - Phone:301-782-9061
Mailing Address - Fax:
Practice Address - Street 1:15908 CRAIN HWY UNIT D
Practice Address - Street 2:
Practice Address - City:BRANDYWINE
Practice Address - State:MD
Practice Address - Zip Code:20613-8032
Practice Address - Country:US
Practice Address - Phone:301-782-9061
Practice Address - Fax:301-782-9063
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD103441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD17278563Medicare UPIN