Provider Demographics
NPI:1639697600
Name:LEO A HAYDT IV DMD II PLLC
Entity Type:Organization
Organization Name:LEO A HAYDT IV DMD II PLLC
Other - Org Name:TRYON FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:PAINTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-747-7888
Mailing Address - Street 1:2720 LAKE WHEELER RD STE 125
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-6440
Mailing Address - Country:US
Mailing Address - Phone:919-787-7888
Mailing Address - Fax:
Practice Address - Street 1:270 CORNERSTONE DR STE 106
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-8400
Practice Address - Country:US
Practice Address - Phone:919-747-7888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty