Provider Demographics
NPI:1871916932
Name:HAYES FAMILY DENTISTRY
Entity type:Organization
Organization Name:HAYES FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:601-664-9300
Mailing Address - Street 1:3823 HIGHWAY 80 E
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PEARL
Mailing Address - State:MS
Mailing Address - Zip Code:39208-4271
Mailing Address - Country:US
Mailing Address - Phone:301-664-9300
Mailing Address - Fax:601-664-1977
Practice Address - Street 1:3823 HWY 80 EAST
Practice Address - Street 2:SUITE 400
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-4232
Practice Address - Country:US
Practice Address - Phone:601-664-9300
Practice Address - Fax:601-664-1977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-27
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3129-00122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty