Provider Demographics
NPI:1396306585
Name:HAYDEN, HOLLY CHANG (DMD)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:CHANG
Last Name:HAYDEN
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 1:2512 E MADISON ST APT 305
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-4757
Mailing Address - Country:US
Mailing Address - Phone:909-451-3300
Mailing Address - Fax:
Practice Address - Street 1:19620 HIGHWAY 99 STE 106
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5565
Practice Address - Country:US
Practice Address - Phone:253-919-4144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18584161223G0001X
WADE61193243122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice