Provider Demographics
NPI:1023761608
Name:MATHIE, HAYLEY CHRISTINE (DDS)
Entity type:Individual
Prefix:DR
First Name:HAYLEY
Middle Name:CHRISTINE
Last Name:MATHIE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6112 MEHRTEN CIR
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-4436
Mailing Address - Country:US
Mailing Address - Phone:612-859-1541
Mailing Address - Fax:
Practice Address - Street 1:6112 MEHRTEN CIR
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-4436
Practice Address - Country:US
Practice Address - Phone:612-859-1541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-02
Last Update Date:2024-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110341122300000X
IL019034136122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist