Provider Demographics
NPI:1447386206
Name:HAMBRICK, HAYWOOD LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:HAYWOOD
Middle Name:LEE
Last Name:HAMBRICK
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 1:1115 EAST 65TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-1202
Mailing Address - Country:US
Mailing Address - Phone:816-523-7766
Mailing Address - Fax:816-523-2263
Practice Address - Street 1:1115 EAST 65TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-1202
Practice Address - Country:US
Practice Address - Phone:816-523-7766
Practice Address - Fax:816-523-2263
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO012136591122300000X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2181OtherDURAL
MO400750402Medicaid
00759025OtherBLUE CROSS