Healthcare Provider Details

I. General information

NPI: 1033591904
Provider Name (Legal Business Name): ROSANNA BAILEY DDS,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2015
Last Update Date: 06/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15908 CRAIN HWY UNIT D
BRANDYWINE MD
20613-8032
US

IV. Provider business mailing address

15908 CRAIN HWY UNIT D
BRANDYWINE MD
20613-8032
US

V. Phone/Fax

Practice location:
  • Phone: 301-782-9061
  • Fax:
Mailing address:
  • Phone: 301-782-9061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number10344
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number10344
License Number StateMD

VIII. Authorized Official

Name: DR. ROSANNA BAILEY
Title or Position: DENTIST
Credential: D.D.S.
Phone: 301-782-9061