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Organization
HAYWARD DENTAL GROUP, P.S.C.
Active
Organization
HAYWARD DENTAL GROUP, P.S.C.
Active
Other names
Fourth Street Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THERESA C. HAYWARD D.M.D. (PRESIDENT)
(502) 585-4320
Entity
Organization
Contact information
Practice address
1018 S 4TH ST, SUITE 250, LOUISVILLE, KY 40203-3221
(502) 585-4320
(502) 585-4355
Mailing address
1018 S 4TH ST, SUITE 250, LOUISVILLE, KY 40203-3221
(502) 585-4320
(502) 585-4355
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
8389
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100011840
—
KY
Enumeration date
04/29/2008
Last updated
04/29/2008
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