Provider Demographics
NPI:1679211973
Name:POPP, HAYLEY RAE (DDS)
Entity Type:Individual
Prefix:DR
First Name:HAYLEY
Middle Name:RAE
Last Name:POPP
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 1:4893 GREEN HILL CT
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-8561
Mailing Address - Country:US
Mailing Address - Phone:586-405-2938
Mailing Address - Fax:
Practice Address - Street 1:10850 E TRAVERSE HWY STE 2250
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-1319
Practice Address - Country:US
Practice Address - Phone:231-946-9644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901601212122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist