Provider Demographics
NPI:1003308909
Name:HORAN, HAYDEN MCKAY (DMD)
Entity type:Individual
Prefix:DR
First Name:HAYDEN
Middle Name:MCKAY
Last Name:HORAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2434 FAIRWAY ST
Mailing Address - Street 2:
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38901-7911
Mailing Address - Country:US
Mailing Address - Phone:662-229-7700
Mailing Address - Fax:662-229-7700
Practice Address - Street 1:1450 OAK ST
Practice Address - Street 2:
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901-4600
Practice Address - Country:US
Practice Address - Phone:662-229-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4006-181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice