Healthcare Provider Details

I. General information

NPI: 1811576143
Provider Name (Legal Business Name): HAYLEY MARIE PATIN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 11/16/2022
Certification Date: 11/16/2022
Deactivation Date: 10/12/2022
Reactivation Date: 11/16/2022

III. Provider practice location address

4441 DIPLOMACY DR
ANCHORAGE AK
99508-5910
US

IV. Provider business mailing address

4441 DIPLOMACY DR
ANCHORAGE AK
99508-5910
US

V. Phone/Fax

Practice location:
  • Phone: 907-729-2000
  • Fax:
Mailing address:
  • Phone: 907-729-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number196839
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: