Provider Demographics
NPI:1679215834
Name:JOELLE HAIRSTON DDS PLLC
Entity type:Organization
Organization Name:JOELLE HAIRSTON DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOELLE
Authorized Official - Middle Name:LAQUITA MARIE
Authorized Official - Last Name:HAIRSTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:912-661-2100
Mailing Address - Street 1:8105 HELMSDALE CT
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-6644
Mailing Address - Country:US
Mailing Address - Phone:912-661-2100
Mailing Address - Fax:
Practice Address - Street 1:107 BULIFANTS BLVD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-5710
Practice Address - Country:US
Practice Address - Phone:757-941-4441
Practice Address - Fax:757-941-4448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-08
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental