Provider Demographics
NPI:1073596987
Name:HAYDEN, CEDRIC ROSS (DDS)
Entity Type:Individual
Prefix:DR
First Name:CEDRIC
Middle Name:ROSS
Last Name:HAYDEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:498 HARLOW RD STE 3
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-1339
Mailing Address - Country:US
Mailing Address - Phone:541-393-7000
Mailing Address - Fax:541-393-7003
Practice Address - Street 1:498 HARLOW RD,
Practice Address - Street 2:SUITE #3
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-1336
Practice Address - Country:US
Practice Address - Phone:541-393-7000
Practice Address - Fax:541-393-7003
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD69581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR68122Medicaid
OR68122Medicaid