Provider Demographics
NPI:1669860904
Name:JESS HAYMORE, DDS,PC
Entity Type:Organization
Organization Name:JESS HAYMORE, DDS,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESS
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-297-2514
Mailing Address - Street 1:1830 E INNOVATION PARK DR
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85755
Mailing Address - Country:US
Mailing Address - Phone:520-297-2514
Mailing Address - Fax:520-297-4627
Practice Address - Street 1:1830 E INNOVATION PARK DR
Practice Address - Street 2:40-49
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85755-1963
Practice Address - Country:US
Practice Address - Phone:520-297-2514
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INNOVATION DENTAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ5698305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization