MEDICARE: DR. ROCKY CHARLES BAYSA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	50859	CA

General Provider Information

NPI Number	:	1306966148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROCKY CHARLES BAYSA

Provider Business Mailing Address
First Line	:	141 SUNSET AVE
Second Line	:	STE. I AND J
City	:	SUISUN CITY
State	:	CA
Zip	:	94585-6347
Country	:	US
Telephone Number	:	707-421-8190
Fax Number	:	707-421-9145

Provider Business Practice Location Address
First Line	:	141 SUNSET AVE
Second Line	:	STE. I AND J
City	:	SUISUN CITY
State	:	CA
Zip	:	94585-6347
Country	:	US
Telephone Number	:	707-421-8190
Fax Number	:	707-421-9145

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	06/18/2008

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