Provider Demographics
NPI:1659985232
Name:HAYDT, NICOLE (DDS)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:HAYDT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:364 W LINDEN DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92865-5000
Mailing Address - Country:US
Mailing Address - Phone:805-390-9438
Mailing Address - Fax:
Practice Address - Street 1:39872 LOS ALAMOS RD STE A1
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5871
Practice Address - Country:US
Practice Address - Phone:951-200-3339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-01
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00204298122300000X
CA1073461223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist