Provider Demographics
NPI:1184751463
Name:HAYMON, LEE TATE (DDS)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:TATE
Last Name:HAYMON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BLADENBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28320-9407
Mailing Address - Country:US
Mailing Address - Phone:910-863-2733
Mailing Address - Fax:
Practice Address - Street 1:581 FARRINGDOM ST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2614
Practice Address - Country:US
Practice Address - Phone:910-738-3913
Practice Address - Fax:910-738-3994
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC60381223P0300X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8993728Medicaid
U41531Medicare UPIN