MEDICARE: HAYLEY E. DEWALDER, DDS, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	8236	NC

General Provider Information

NPI Number	:	1407190242
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAYLEY E. DEWALDER, DDS, PLLC

Provider Business Mailing Address
First Line	:	235 ST JOHNS RD
Second Line	:	SUITE 110
City	:	FLETCHER
State	:	NC
Zip	:	28732-8334
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	235 ST JOHNS RD
Second Line	:	SUITE 110
City	:	FLETCHER
State	:	NC
Zip	:	28732-8334
Country	:	US
Telephone Number	:	828-654-7450
Fax Number	:	828-654-8665

Authorized Official
Title or Position	:	OWNER
Name	:	HAYLEY E. DEWALDER
Credential	:
Telephone Number	:	828-318-4071

Provider Enumeration Date	:	11/17/2012
Last Update Date	:	11/17/2012

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