Provider Demographics
NPI:1962170829
Name:HAILEY, JASMINE DANIELLE
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:DANIELLE
Last Name:HAILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JASMINE
Other - Middle Name:DANIELLE
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:557 TUCKER VIEW DR
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-6651
Mailing Address - Country:US
Mailing Address - Phone:901-679-4657
Mailing Address - Fax:
Practice Address - Street 1:5270 POPLAR AVE STE 101
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3515
Practice Address - Country:US
Practice Address - Phone:901-255-3459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-03
Last Update Date:2025-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11807122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist