Provider Demographics
NPI:1831198050
Name:HAYUTIN, DAVID JOEL (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JOEL
Last Name:HAYUTIN
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 1:5055 E KENTUCKY AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-3900
Mailing Address - Country:US
Mailing Address - Phone:303-757-8844
Mailing Address - Fax:303-759-0994
Practice Address - Street 1:5055 E KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-3900
Practice Address - Country:US
Practice Address - Phone:303-757-8844
Practice Address - Fax:303-759-0994
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO61811223P0221X
WY9151223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02061810Medicaid