MEDICARE: SANDRA BAGLEY

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	124Q00000X	Dental Hygienist	DH000903570	CO

General Provider Information

NPI Number	:	1447611710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA BAGLEY

Provider Business Mailing Address
First Line	:	1532 GALENA ST
Second Line	:	STE 380
City	:	AURORA
State	:	CO
Zip	:	80010-2287
Country	:	US
Telephone Number	:	303-526-8129
Fax Number	:

Provider Business Practice Location Address
First Line	:	1532 GALENA ST
Second Line	:	STE 380
City	:	AURORA
State	:	CO
Zip	:	80010-2287
Country	:	US
Telephone Number	:	303-526-8129
Fax Number	:

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

Provider Enumeration Date	:	03/15/2016
Last Update Date	:	03/15/2016

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Directions to “ SANDRA BAGLEY ” Practice Location

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