Provider Demographics
NPI:1689869612
Name:HAYET, BOB (DMD)
Entity Type:Individual
Prefix:DR
First Name:BOB
Middle Name:
Last Name:HAYET
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 1:1199 AMBOY AVENUE
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-2522
Mailing Address - Country:US
Mailing Address - Phone:732-548-6585
Mailing Address - Fax:732-548-6589
Practice Address - Street 1:1199 AMBOY AVENUE
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-2522
Practice Address - Country:US
Practice Address - Phone:732-548-6585
Practice Address - Fax:732-548-6589
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1013884001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice