Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 61237 | CA |
NPI | 1063761609 |
---|---|
Provider Name | Dr. Melissa Bailey |
First Address | Pleasanton, CA 94566-7705 |
Second Address | San Ramon, CA 94582-5056 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2012 |
Last Update Date | 31/01/2022 |