Provider Demographics
NPI:1679947246
Name:HAYES, DEREK HUNTER (DMD)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:HUNTER
Last Name:HAYES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 JENNY CT
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-4764
Mailing Address - Country:US
Mailing Address - Phone:270-791-5589
Mailing Address - Fax:
Practice Address - Street 1:1430 JENNY CT
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-4764
Practice Address - Country:US
Practice Address - Phone:270-791-5589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-19
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9695122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist