Provider Demographics
NPI:1134436975
Name:HAYGOOD DENTAL CARE, LLC
Entity type:Organization
Organization Name:HAYGOOD DENTAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:HAYGOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:318-741-6778
Mailing Address - Street 1:1519 DOCTORS DR STE 1
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-3676
Mailing Address - Country:US
Mailing Address - Phone:318-741-6778
Mailing Address - Fax:318-741-6778
Practice Address - Street 1:1519 DOCTORS DR STE 1
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-3676
Practice Address - Country:US
Practice Address - Phone:318-741-6778
Practice Address - Fax:318-741-6778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5334122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty