Provider Demographics
NPI:1407273139
Name:SAMUEL HAYATT DMD, INC.
Entity Type:Organization
Organization Name:SAMUEL HAYATT DMD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MAYRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:619-428-5555
Mailing Address - Street 1:1530 HILTON HEAD RD STE 111
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-4655
Mailing Address - Country:US
Mailing Address - Phone:619-441-8000
Mailing Address - Fax:619-441-8012
Practice Address - Street 1:1530 HILTON HEAD RD STE 111
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-4655
Practice Address - Country:US
Practice Address - Phone:619-441-8000
Practice Address - Fax:619-441-8012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-19
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA557811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty