Provider Demographics
NPI:1659557411
Name:HAYWARD, DAVID PETER (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:PETER
Last Name:HAYWARD
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 1:4355 SUWANEE DAM RD
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6707
Mailing Address - Country:US
Mailing Address - Phone:770-614-7300
Mailing Address - Fax:770-614-7911
Practice Address - Street 1:4355 SUWANEE DAM RD.
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6705
Practice Address - Country:US
Practice Address - Phone:770-614-7300
Practice Address - Fax:770-614-7911
Is Sole Proprietor?:No
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN008871122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist