Provider Demographics
NPI:1790117844
Name:HAYASHI DENTAL CORPORATION
Entity Type:Organization
Organization Name:HAYASHI DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:T
Authorized Official - Last Name:HAYASHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-604-5666
Mailing Address - Street 1:531 W KETTLEMAN LN
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-6005
Mailing Address - Country:US
Mailing Address - Phone:209-366-1850
Mailing Address - Fax:209-333-1879
Practice Address - Street 1:531 W KETTLEMAN LN
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-6005
Practice Address - Country:US
Practice Address - Phone:209-366-1850
Practice Address - Fax:209-333-1879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36765122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty