Healthcare Provider Details

I. General information

NPI: 1821301748
Provider Name (Legal Business Name): ASHELY ANNE HAYES R.D.H
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2010
Last Update Date: 07/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22629 TWAIN HARTE DR
TWAIN HARTE CA
95383-9405
US

IV. Provider business mailing address

525 BARRETTA ST APT D
SONORA CA
95370-5115
US

V. Phone/Fax

Practice location:
  • Phone: 209-586-2772
  • Fax:
Mailing address:
  • Phone: 209-324-0835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number25076
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: