Provider Demographics
NPI:1710110937
Name:MICHAEL HAYMORE, DDS, PLLC
Entity Type:Organization
Organization Name:MICHAEL HAYMORE, DDS, PLLC
Other - Org Name:INNOVATION DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:HAYMORE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
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:85755-1963
Mailing Address - Country:US
Mailing Address - Phone:520-297-2514
Mailing Address - Fax:529-297-4627
Practice Address - Street 1:1830 E INNOVATION PARK DR
Practice Address - Street 2:
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:529-297-4627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-03
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ78081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty