Provider Demographics
NPI:1235533456
Name:HAYJACK INDUSTRIES
Entity Type:Organization
Organization Name:HAYJACK INDUSTRIES
Other - Org Name:GENTLE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAYWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-924-0223
Mailing Address - Street 1:3740 S UNIVERSITY DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-3700
Mailing Address - Country:US
Mailing Address - Phone:817-924-0223
Mailing Address - Fax:
Practice Address - Street 1:3740 S UNIVERSITY DR
Practice Address - Street 2:SUITE 203
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-3700
Practice Address - Country:US
Practice Address - Phone:817-924-0223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX131041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty