Provider Demographics
NPI:1043953821
Name:HAYGOOD, DALE LANDFORD JR
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:LANDFORD
Last Name:HAYGOOD
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2046 HARVARD BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-4544
Mailing Address - Country:US
Mailing Address - Phone:937-305-5898
Mailing Address - Fax:
Practice Address - Street 1:2046 HARVARD BLVD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-4544
Practice Address - Country:US
Practice Address - Phone:937-305-5898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide