Provider Demographics
NPI:1083308563
Name:AL BAYATI, RANIAH
Entity type:Individual
Prefix:
First Name:RANIAH
Middle Name:
Last Name:AL BAYATI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RANIAH
Other - Middle Name:
Other - Last Name:AL BAYATI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4212 MISSOURI FLAT RD
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-6269
Mailing Address - Country:US
Mailing Address - Phone:530-621-7700
Mailing Address - Fax:
Practice Address - Street 1:4212 MISSOURI FLAT RD
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-6269
Practice Address - Country:US
Practice Address - Phone:530-621-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA186831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program