Healthcare Provider Details

I. General information

NPI: 1912429358
Provider Name (Legal Business Name): SARA BAILEY DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2017
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2109 CUMING ST
OMAHA NE
68102-4325
US

IV. Provider business mailing address

2109 CUMING ST
OMAHA NE
68102-4325
US

V. Phone/Fax

Practice location:
  • Phone: 307-251-0915
  • Fax:
Mailing address:
  • Phone: 402-280-5034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7878
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1472
License Number StateWY
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0006794-C1
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: