Provider Demographics
NPI:1134311004
Name:HAYES, KRISTY LYNN (DMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTY
Middle Name:LYNN
Last Name:HAYES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 LAUREL ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-1472
Mailing Address - Country:US
Mailing Address - Phone:619-291-5266
Mailing Address - Fax:619-291-0124
Practice Address - Street 1:239 LAUREL ST
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-1472
Practice Address - Country:US
Practice Address - Phone:619-291-5266
Practice Address - Fax:619-291-0124
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0226321223G0001X, 1223P0221X
CA642511223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice