Provider Demographics
NPI:1821301748
Name:HAYES, ASHELY ANNE (RDH)
Entity Type:Individual
Prefix:
First Name:ASHELY
Middle Name:ANNE
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 1:525 BARRETTA ST APT D
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-5115
Mailing Address - Country:US
Mailing Address - Phone:209-324-0835
Mailing Address - Fax:
Practice Address - Street 1:22629 TWAIN HARTE DR
Practice Address - Street 2:
Practice Address - City:TWAIN HARTE
Practice Address - State:CA
Practice Address - Zip Code:95383-9405
Practice Address - Country:US
Practice Address - Phone:209-586-2772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-20
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25076124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist