Provider Demographics
NPI:1689781189
Name:HAYMOND, CREED S (DDS)
Entity Type:Individual
Prefix:DR
First Name:CREED
Middle Name:S
Last Name:HAYMOND
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 1:1434 E 9400 S
Mailing Address - Street 2:STE 102
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093
Mailing Address - Country:US
Mailing Address - Phone:801-576-0077
Mailing Address - Fax:801-495-1837
Practice Address - Street 1:1434 E 9400 S
Practice Address - Street 2:STE 102
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84093
Practice Address - Country:US
Practice Address - Phone:801-576-0077
Practice Address - Fax:801-495-1837
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14537899241223S0112X
UT14537889031223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
I45378Medicare UPIN
000010305Medicare ID - Type Unspecified