Healthcare Provider Details

I. General information

NPI: 1568549038
Provider Name (Legal Business Name): ROSE HARUKO BAILEY DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 5TH AVE SE STE 101
OLYMPIA WA
98501-1505
US

IV. Provider business mailing address

911 5TH AVE SE STE 101
OLYMPIA WA
98501-1505
US

V. Phone/Fax

Practice location:
  • Phone: 360-352-9391
  • Fax: 360-753-6164
Mailing address:
  • Phone: 360-352-9391
  • Fax: 360-753-6164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7716
License Number StateWA

VIII. Authorized Official

Name: DR. ROSE H. BAILEY
Title or Position: OWNER
Credential: DDS
Phone: 360-352-9391