Provider Demographics
NPI:1477668176
Name:HAYES, SAMUEL L (DDS)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:L
Last Name:HAYES
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 1:232 COLLINGWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45419-3908
Mailing Address - Country:US
Mailing Address - Phone:813-732-1456
Mailing Address - Fax:
Practice Address - Street 1:232 COLLINGWOOD AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45419-3908
Practice Address - Country:US
Practice Address - Phone:813-732-1456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2012-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010180801223S0112X
NC92571223S0112X
OH30.0233821223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery