Provider Demographics
NPI:1629408927
Name:HAYES, MELISSA (DMD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
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 1:955 PARK AVE N STE D
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-5680
Mailing Address - Country:US
Mailing Address - Phone:425-793-6003
Mailing Address - Fax:425-793-3505
Practice Address - Street 1:955 PARK AVE N STE D
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057
Practice Address - Country:US
Practice Address - Phone:425-793-6003
Practice Address - Fax:425-793-3505
Is Sole Proprietor?:No
Enumeration Date:2013-11-22
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60396806122300000X
MT60831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist