Provider Demographics
NPI:1376558106
Name:HAYE DENTAL GROUP
Entity Type:Organization
Organization Name:HAYE DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:OSTRANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-752-7931
Mailing Address - Street 1:107 N CROSBY AVE
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548-3333
Mailing Address - Country:US
Mailing Address - Phone:608-752-7931
Mailing Address - Fax:608-752-4826
Practice Address - Street 1:107 N CROSBY AVE
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-3333
Practice Address - Country:US
Practice Address - Phone:608-752-7931
Practice Address - Fax:608-752-4826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3949-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty