Provider Demographics
NPI:1932511060
Name:HAYTER, RAECHELLE (DDS)
Entity Type:Individual
Prefix:
First Name:RAECHELLE
Middle Name:
Last Name:HAYTER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 E WALNUT LAWN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4202
Mailing Address - Country:US
Mailing Address - Phone:417-374-1685
Mailing Address - Fax:
Practice Address - Street 1:1250 E WALNUT LAWN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-4202
Practice Address - Country:US
Practice Address - Phone:417-374-1685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-23
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20130173071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice