Provider Demographics
NPI:1609038025
Name:HAYES, ROSA SELINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROSA
Middle Name:SELINA
Last Name:HAYES
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 1:2038 MILBREY ST
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-3008
Mailing Address - Country:US
Mailing Address - Phone:901-757-0765
Mailing Address - Fax:
Practice Address - Street 1:2845 N HOUSTON LEVEE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-0179
Practice Address - Country:US
Practice Address - Phone:901-266-0555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN87271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice