Provider Demographics
NPI:1548568124
Name:HAYDEN RUN DENTISTRY
Entity Type:Organization
Organization Name:HAYDEN RUN DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:MICHALAK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:614-534-0688
Mailing Address - Street 1:4986 COSGRAY RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-8337
Mailing Address - Country:US
Mailing Address - Phone:614-534-0688
Mailing Address - Fax:614-534-0699
Practice Address - Street 1:4986 COSGRAY RD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-8337
Practice Address - Country:US
Practice Address - Phone:614-534-0688
Practice Address - Fax:614-534-0699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-07
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0225741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty