=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700729043
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HYGIENE HEAVEN DENTAL WELLNESS & CO.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/13/2026
-----------------------------------------------------
Last Update Date | 04/13/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2101 MEMORY LN
-----------------------------------------------------
City | HARKER HEIGHTS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76548-3335
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-777-1111
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2201 LOOKOUT KNOLL DR
-----------------------------------------------------
City | LEANDER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78641-4952
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-315-0558
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. KIMBERLY NICOLE HAYNES
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 210-315-0558
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------