Provider Demographics
NPI:1497809875
Name:HASTON, WAYMON (DDS)
Entity Type:Individual
Prefix:
First Name:WAYMON
Middle Name:
Last Name:HASTON
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 1:9-A HAMPTON DRIVE
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:TN
Mailing Address - Zip Code:38583
Mailing Address - Country:US
Mailing Address - Phone:931-836-2157
Mailing Address - Fax:931-836-2273
Practice Address - Street 1:9-A HAMPTON DRIVE
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:TN
Practice Address - Zip Code:38583
Practice Address - Country:US
Practice Address - Phone:931-836-2157
Practice Address - Fax:931-836-2273
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6843122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist