Provider Demographics
NPI:1891212403
Name:HAYWARD SMILES, PRACTICE OF MEDYNSKI DENTAL CORP
Entity Type:Organization
Organization Name:HAYWARD SMILES, PRACTICE OF MEDYNSKI DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDYNSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:510-264-2000
Mailing Address - Street 1:27171 CALAROGA AVE STE 11
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-4344
Mailing Address - Country:US
Mailing Address - Phone:510-264-2000
Mailing Address - Fax:510-264-2005
Practice Address - Street 1:27171 CALAROGA AVE STE 11
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-4344
Practice Address - Country:US
Practice Address - Phone:510-264-2000
Practice Address - Fax:510-264-2005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62093261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental