Provider Demographics
NPI:1518247857
Name:JULIAN HAYWOOD DDS PA
Entity Type:Organization
Organization Name:JULIAN HAYWOOD DDS PA
Other - Org Name:WESTWOOD DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-484-0880
Mailing Address - Street 1:5318 NC HIGHWAY 55
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-9659
Mailing Address - Country:US
Mailing Address - Phone:919-484-0880
Mailing Address - Fax:919-484-0888
Practice Address - Street 1:5318 NC HIGHWAY 55
Practice Address - Street 2:SUITE 101
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-9659
Practice Address - Country:US
Practice Address - Phone:919-484-0880
Practice Address - Fax:919-484-0888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-18
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC73681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1760539308OtherINDIVIDUAL NPI
NC89902FNMedicaid