Provider Demographics
NPI:1447398136
Name:HAYWARD, THERESA C I (DMD)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:C I
Last Name:HAYWARD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:THERESA
Other - Middle Name:C
Other - Last Name:IWU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:146 DARBY WOODS CT
Mailing Address - Street 2:
Mailing Address - City:RADCLIFF
Mailing Address - State:KY
Mailing Address - Zip Code:40160-8604
Mailing Address - Country:US
Mailing Address - Phone:502-445-2652
Mailing Address - Fax:
Practice Address - Street 1:309 N WILSON RD
Practice Address - Street 2:
Practice Address - City:RADCLIFF
Practice Address - State:KY
Practice Address - Zip Code:40160-2194
Practice Address - Country:US
Practice Address - Phone:270-352-4343
Practice Address - Fax:270-352-4373
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY83891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice