Healthcare Provider Details

I. General information

NPI: 1063103497
Provider Name (Legal Business Name): HALEY LYNNE HILDRETH DMD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8324 MERCHANTS WAY UNIT 9
JACKSONVILLE FL
32222-2946
US

IV. Provider business mailing address

8324 MERCHANTS WAY UNIT 9
JACKSONVILLE FL
32222-2946
US

V. Phone/Fax

Practice location:
  • Phone: 904-529-0585
  • Fax:
Mailing address:
  • Phone: 904-529-0585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number13747
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number32491
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: