Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 21689 | CA |
NPI | 1063508737 |
---|---|
Provider Name | James Bailey JR. |
First Address | Oakland, CA 94605-5038 |
Second Address | Concord, CA 94520-2520 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 29/12/2016 |