Provider Demographics
NPI:1023194172
Name:HAYDEN, SUSIE STAFFORD (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUSIE
Middle Name:STAFFORD
Last Name:HAYDEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19503 ENCINO SPUR ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-2305
Mailing Address - Country:US
Mailing Address - Phone:210-491-4141
Mailing Address - Fax:210-494-4025
Practice Address - Street 1:20322 HUEBNER RD
Practice Address - Street 2:SUITE #103
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258
Practice Address - Country:US
Practice Address - Phone:210-491-4141
Practice Address - Fax:210-494-4025
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX168391223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry