Provider Demographics
NPI:1003280124
Name:DRANE, HAYWARD BENTON IV (DMD)
Entity Type:Individual
Prefix:DR
First Name:HAYWARD
Middle Name:BENTON
Last Name:DRANE
Suffix:IV
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:CHRISTIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:1 CHESLEY DRIVE
Mailing Address - Street 2:CLUSTERS UNIT
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063
Mailing Address - Country:US
Mailing Address - Phone:610-566-6649
Mailing Address - Fax:610-566-6740
Practice Address - Street 1:1 CHESLEY DRIVE
Practice Address - Street 2:CLUSTERS UNIT
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063
Practice Address - Country:US
Practice Address - Phone:610-566-6649
Practice Address - Fax:610-566-6740
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-01
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0392621223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics