Provider Demographics
NPI:1265030811
Name:DODSON, HAILEY (DMD)
Entity Type:Individual
Prefix:DR
First Name:HAILEY
Middle Name:
Last Name:DODSON
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 1:1926 W BURNSIDE ST UNIT 309
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-2068
Mailing Address - Country:US
Mailing Address - Phone:541-261-4142
Mailing Address - Fax:
Practice Address - Street 1:907 NW 18TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2324
Practice Address - Country:US
Practice Address - Phone:971-544-7403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD11335122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist