Provider Demographics
NPI:1376605857
Name:HAYES, ROBERT BRAD (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BRAD
Last Name:HAYES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3823 HIGHWAY 80 E STE 400
Mailing Address - Street 2:
Mailing Address - City:PEARL
Mailing Address - State:MS
Mailing Address - Zip Code:39208-4275
Mailing Address - Country:US
Mailing Address - Phone:601-664-0456
Mailing Address - Fax:
Practice Address - Street 1:26652 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:MS
Practice Address - Zip Code:39773-7544
Practice Address - Country:US
Practice Address - Phone:662-494-1869
Practice Address - Fax:662-494-7883
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3129-001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00660393Medicaid