Healthcare Provider Details

I. General information

NPI: 1679486492
Provider Name (Legal Business Name): YULIA BRIANN HALEY EPDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 HAWTHORNE AVE SE STE 200
SALEM OR
97301-5378
US

IV. Provider business mailing address

2514 WHITE HORSE CT NW
SALEM OR
97304-4254
US

V. Phone/Fax

Practice location:
  • Phone: 800-525-6800
  • Fax:
Mailing address:
  • Phone: 541-671-7366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH8220
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: