Provider Demographics
NPI:1407422835
Name:HAYDON, BEAU B (DDS)
Entity Type:Individual
Prefix:
First Name:BEAU
Middle Name:B
Last Name:HAYDON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4516 EATON ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66103-3529
Mailing Address - Country:US
Mailing Address - Phone:314-601-1654
Mailing Address - Fax:
Practice Address - Street 1:4760 W MINERAL AVE STE 60
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80128-2540
Practice Address - Country:US
Practice Address - Phone:720-222-2345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00204678122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist