Healthcare Provider Details

I. General information

NPI: 1619968211
Provider Name (Legal Business Name): SUZANNE WATSON HAYES DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 02/01/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 OLD MCMINNVILLE ST
SPENCER TN
38585-3200
US

IV. Provider business mailing address

1100 ENGLAND DR
COOKEVILLE TN
38501-0924
US

V. Phone/Fax

Practice location:
  • Phone: 931-946-2438
  • Fax: 931-946-2643
Mailing address:
  • Phone: 931-520-4466
  • Fax: 931-520-3871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberDS0000007272
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: