Provider Demographics
NPI:1386824431
Name:HAYDT, NICOLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:HAYDT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 S CEDAR CREST BLVD
Mailing Address - Street 2:SUITE 312-C
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6205
Mailing Address - Country:US
Mailing Address - Phone:610-437-2677
Mailing Address - Fax:610-437-8402
Practice Address - Street 1:1251 S CEDAR CREST BLVD
Practice Address - Street 2:SUITE 312-C
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6205
Practice Address - Country:US
Practice Address - Phone:610-437-2677
Practice Address - Fax:610-437-8402
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADSO371111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice