Provider Demographics
NPI:1093971178
Name:BEAUDETTE, HAYLEY CECILLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:HAYLEY
Middle Name:CECILLE
Last Name:BEAUDETTE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3727 AVENUE D
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-4642
Mailing Address - Country:US
Mailing Address - Phone:308-632-6331
Mailing Address - Fax:308-633-1362
Practice Address - Street 1:3727 AVENUE D
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4642
Practice Address - Country:US
Practice Address - Phone:308-632-6331
Practice Address - Fax:308-633-1362
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-29
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6748122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist