Healthcare Provider Details

I. General information

NPI: 1134050867
Provider Name (Legal Business Name): DYLAN ALEXANDER HAYES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1138 W 26TH ST
LYNN HAVEN FL
32444-4733
US

IV. Provider business mailing address

1307 NEW JERSEY AVE
LYNN HAVEN FL
32444-2050
US

V. Phone/Fax

Practice location:
  • Phone: 850-813-5665
  • Fax:
Mailing address:
  • Phone: 205-567-7955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN31667
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: