Provider Demographics
NPI:1629372941
Name:HAYES, PHILLIP WARREN (DDS)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:WARREN
Last Name:HAYES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 W CHERRY AVE
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3402
Mailing Address - Country:US
Mailing Address - Phone:559-781-4818
Mailing Address - Fax:559-781-8831
Practice Address - Street 1:240 W CHERRY AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3402
Practice Address - Country:US
Practice Address - Phone:559-781-4818
Practice Address - Fax:559-781-8831
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA267621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice