Healthcare Provider Details

I. General information

NPI: 1902759103
Provider Name (Legal Business Name): CHRISTOPHER HAILEY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2026
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 BANK ST
GRASS VALLEY CA
95945-6520
US

IV. Provider business mailing address

8455 QUAIL OAKS DR
GRANITE BAY CA
95746-6073
US

V. Phone/Fax

Practice location:
  • Phone: 530-273-4814
  • Fax:
Mailing address:
  • Phone: 916-223-4449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number112424
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: