Provider Demographics
NPI:1083593958
Name:HAYES, KIMBERLY D (RDH)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:D
Last Name:HAYES
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:D
Other - Last Name:MUSGRAVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:3716 WAYFARER WAY
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-7402
Mailing Address - Country:US
Mailing Address - Phone:863-709-7122
Mailing Address - Fax:863-709-7122
Practice Address - Street 1:3716 WAYFARER WAY
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-7402
Practice Address - Country:US
Practice Address - Phone:863-709-7122
Practice Address - Fax:863-709-7122
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH12032124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty