Provider Demographics
NPI:1003513540
Name:WIDNER, HAYLEY JAMES
Entity Type:Individual
Prefix:
First Name:HAYLEY
Middle Name:JAMES
Last Name:WIDNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HAYLEY
Other - Middle Name:ROSE
Other - Last Name:JAMES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDH
Mailing Address - Street 1:3D DENTAL BATTALION, 3D MLG
Mailing Address - Street 2:UNIT 38450
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96373
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3D DENTAL BATTALION, 3D MLG
Practice Address - Street 2:UNIT 38450
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96373
Practice Address - Country:US
Practice Address - Phone:315-645-3406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12494124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist