Healthcare Provider Details

I. General information

NPI: 1063508737
Provider Name (Legal Business Name): JAMES BAILEY JR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 12/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1851 SUTTER ST
CONCORD CA
94520-2520
US

IV. Provider business mailing address

10514 ROYAL OAK RD
OAKLAND CA
94605-5038
US

V. Phone/Fax

Practice location:
  • Phone: 925-827-2798
  • Fax:
Mailing address:
  • Phone: 510-632-8396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number21689
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: