Provider Demographics
NPI:1447134960
Name:BURGESS, HALEY NANALINE (DMD)
Entity type:Individual
Prefix:DR
First Name:HALEY
Middle Name:NANALINE
Last Name:BURGESS
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 1:408 18TH ST E
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501-5456
Mailing Address - Country:US
Mailing Address - Phone:706-525-8258
Mailing Address - Fax:
Practice Address - Street 1:1206 HIGHWAY 78 E
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-3939
Practice Address - Country:US
Practice Address - Phone:205-387-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD.007537-C1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist