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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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