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General NPI Number Information
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NPI Number | 1083708804
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Entity Type | Individual
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Provider Name | HAYLEY ELIZABETH DEWALDER DDS
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Gender | Female
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 10/20/2022
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Provider Practice Location Address
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Address Line | 1226 OHIO AVE
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City | DUNBAR
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State | WV
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Zip | 25064-3020
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Country | US
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Telephone | 304-768-5616
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Fax | 304-768-5617
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Provider Business Mailing Address
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Address Line | 1226 OHIO AVE
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City | DUNBAR
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State | WV
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Zip | 25064-3020
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Country | US
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Telephone | 304-768-5616
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Fax | 304-768-5617
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 8236
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3674
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License Number State | WV
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