Provider Demographics
NPI:1134465651
Name:R.T. HAYASHI, DDS, INC.
Entity Type:Organization
Organization Name:R.T. HAYASHI, DDS, INC.
Other - Org Name:MODERN DENTAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:T
Authorized Official - Last Name:HAYASHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-489-9990
Mailing Address - Street 1:5723 MARCONI AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-4475
Mailing Address - Country:US
Mailing Address - Phone:916-489-9990
Mailing Address - Fax:916-489-9998
Practice Address - Street 1:5723 MARCONI AVE
Practice Address - Street 2:SUITE A
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-4475
Practice Address - Country:US
Practice Address - Phone:916-489-9990
Practice Address - Fax:916-489-9998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36765302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1598867396Medicaid