Provider Demographics
NPI:1851665871
Name:SAMUEL HAYATT DMD INC.
Entity Type:Organization
Organization Name:SAMUEL HAYATT DMD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYATT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:619-482-5555
Mailing Address - Street 1:2260 OTAY LAKES RD
Mailing Address - Street 2:110
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915-1005
Mailing Address - Country:US
Mailing Address - Phone:619-482-5555
Mailing Address - Fax:619-482-5155
Practice Address - Street 1:2260 OTAY LAKES RD
Practice Address - Street 2:110
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91915-1005
Practice Address - Country:US
Practice Address - Phone:619-482-5555
Practice Address - Fax:619-482-5155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55781122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty