Provider Demographics
NPI:1982000832
Name:BAILEY, SHAWNA (RDHAP)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19947 1ST ST STE 3
Mailing Address - Street 2:BOX 191
Mailing Address - City:HILMAR
Mailing Address - State:CA
Mailing Address - Zip Code:95324-9071
Mailing Address - Country:US
Mailing Address - Phone:209-585-1785
Mailing Address - Fax:
Practice Address - Street 1:19947 1ST ST STE 3
Practice Address - Street 2:BOX 191
Practice Address - City:HILMAR
Practice Address - State:CA
Practice Address - Zip Code:95324-9071
Practice Address - Country:US
Practice Address - Phone:209-585-1785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDHAP 546124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist