Basic Information
| Provider Information | |||||||||
| NPI: | 1629408927 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAYES | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | |||||||||
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| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 955 PARK AVE N STE D | ||||||||
| Address2: | |||||||||
| City: | RENTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980575680 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4257936003 | ||||||||
| FaxNumber: | 4257933505 | ||||||||
| Practice Location | |||||||||
| Address1: | 955 PARK AVE N STE D | ||||||||
| Address2: | |||||||||
| City: | RENTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4257936003 | ||||||||
| FaxNumber: | 4257933505 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2013 | ||||||||
| LastUpdateDate: | 07/03/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 60396806 | WA | N | Dental Providers | Dentist | 1223G0001X | 6083 | MT | Y | Dental Providers | Dentist | General Practice |
No ID Information.