Provider Demographics
NPI:1457574097
Name:HAYES, SANDRA DARLENE (DMD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:DARLENE
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 1:6867 BRIERY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-9379
Mailing Address - Country:US
Mailing Address - Phone:931-526-1614
Mailing Address - Fax:931-525-1236
Practice Address - Street 1:620 E 10TH ST
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-1810
Practice Address - Country:US
Practice Address - Phone:931-526-1614
Practice Address - Fax:631-525-1236
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000046691223G0001X
KY65471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice