Provider Demographics
NPI:1760569479
Name:BAILEY, ROSE H (DDS)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:H
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 1:911 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA77161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice