Provider Demographics
NPI:1972335271
Name:BURNETTE, HAILEY
Entity type:Individual
Prefix:
First Name:HAILEY
Middle Name:
Last Name:BURNETTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 KEENELAND DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-3165
Mailing Address - Country:US
Mailing Address - Phone:931-303-1854
Mailing Address - Fax:
Practice Address - Street 1:4935 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-2735
Practice Address - Country:US
Practice Address - Phone:615-302-1414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000010543124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist