Provider Demographics
NPI:1649818758
Name:CORBIN HAYTER DDS LLC
Entity type:Organization
Organization Name:CORBIN HAYTER DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CORBIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:HAYTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:417-527-7222
Mailing Address - Street 1:3259 E SUNSHINE ST STE HH
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2160
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3259 E SUNSHINE ST STE HH
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2160
Practice Address - Country:US
Practice Address - Phone:417-887-7701
Practice Address - Fax:417-881-7327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-19
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental