Provider Demographics
NPI:1346309226
Name:HAYES, SCOTT
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:HAYES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 N HOLLAND RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-9006
Mailing Address - Country:US
Mailing Address - Phone:682-518-5003
Mailing Address - Fax:682-518-0116
Practice Address - Street 1:717 N HOLLAND RD
Practice Address - Street 2:SUITE 120
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-9006
Practice Address - Country:US
Practice Address - Phone:682-518-5003
Practice Address - Fax:682-518-0116
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX215071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice