Provider Demographics
NPI:1710046685
Name:HAYES, CASEY (RDH)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:HAYES
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 110425
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35211-0425
Mailing Address - Country:US
Mailing Address - Phone:205-324-5130
Mailing Address - Fax:205-324-5188
Practice Address - Street 1:3200 27TH ST N
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35207-4554
Practice Address - Country:US
Practice Address - Phone:205-324-5130
Practice Address - Fax:205-324-5188
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5522124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist