Raniah Al Bayati

Individual provider Active NPI General Practice Dentistry · Placerville, CA

NPI 1083308563 · NPPES record last updated Jul 29, 2025

Key facts

NPI
1083308563
Entity type
Individual (NPI type 1)
Primary specialty
General Practice Dentistry 1223G0001X
License
18683 (CA)
Practice address
4212 Missouri Flat Rd
Placerville, CA 95667-6269
Phone
(530) 621-7700
NPI assigned
Jun 7, 2023
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
I20250814000530 CA Order and Referring Only - Dentist
Practitioner - Dentist
8224536610

National Provider Directory

Medicare enrollment (NPD)
Yes

State licenses

LicenseStateTypeSpecialty
112004CAMDMarriage & Family Therapist
18683CAMDGeneral Practice Dentistry

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
General Practice Dentistry 1223G0001X 18683 CA Yes

Addresses

Primary practice location

4212 Missouri Flat Rd
Placerville, CA 95667-6269

Mailing address

4212 Missouri Flat Rd
Placerville, CA 95667-6269
Phone (530) 621-7700

Other names

  • Raniah Al Bayati Professional name

Other providers in Placerville, CA

All providers in Placerville, CA · General Practice Dentistry in California

Sources for this page

Verify at the official NPI Registry.