Provider Demographics
NPI:1598850497
Name:HAYES, JOHN P (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
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 1:811 TRAIL RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:IN
Mailing Address - Zip Code:46701-1534
Mailing Address - Country:US
Mailing Address - Phone:260-636-7374
Mailing Address - Fax:260-636-7376
Practice Address - Street 1:811 TRAIL RIDGE RD
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:IN
Practice Address - Zip Code:46701-1534
Practice Address - Country:US
Practice Address - Phone:260-636-7374
Practice Address - Fax:260-636-7376
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007945A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100190870A *21Medicaid