Provider Demographics
NPI:1124349832
Name:HAYS, JENNIFER ROBYN (DMD, PEDIATRIC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ROBYN
Last Name:HAYS
Suffix:
Gender:F
Credentials:DMD, PEDIATRIC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ROBYN
Other - Last Name:ROSSEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1800 COMMUNITY
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MO
Mailing Address - Zip Code:64735-8804
Mailing Address - Country:US
Mailing Address - Phone:660-885-8131
Mailing Address - Fax:
Practice Address - Street 1:1600 N MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:MARCELINE
Practice Address - State:MO
Practice Address - Zip Code:64658-1012
Practice Address - Country:US
Practice Address - Phone:844-853-8937
Practice Address - Fax:660-376-3454
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20210146731223P0221X
MO20200211081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO400086730Medicaid