Provider Demographics
NPI:1558854588
Name:HATTENHAUER, ALAYNA (DDS)
Entity Type:Individual
Prefix:
First Name:ALAYNA
Middle Name:
Last Name:HATTENHAUER
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 1:507 HUTSON ST
Mailing Address - Street 2:
Mailing Address - City:BLYTHEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72315-2415
Mailing Address - Country:US
Mailing Address - Phone:870-762-5274
Mailing Address - Fax:870-762-5280
Practice Address - Street 1:507 HUTSON ST
Practice Address - Street 2:
Practice Address - City:BLYTHEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72315-2415
Practice Address - Country:US
Practice Address - Phone:870-762-5274
Practice Address - Fax:870-762-5280
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR42831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice