# HAYWARD DENTAL GROUP, P.S.C.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Fourth Street Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1942475934
- **Authorized official:** DR. THERESA C. HAYWARD D.M.D. (PRESIDENT)
- **Authorized official phone:** (502) 585-4320

## Contact information

- **Practice address:** 1018 S 4TH ST, SUITE 250, LOUISVILLE, KY 40203-3221
- **Practice address phone:** (502) 585-4320
- **Practice address fax:** (502) 585-4355
- **Mailing address:** 1018 S 4TH ST, SUITE 250, LOUISVILLE, KY 40203-3221
- **Mailing address phone:** (502) 585-4320
- **Mailing address fax:** (502) 585-4355

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 8389 | KY | Yes |

## Other

- **Enumeration date:** 04/29/2008
- **Last updated:** 04/29/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 7100011840 | — | KY |