Provider Demographics
NPI:1831339829
Name:CREED S HAYMOND DDS PC
Entity type:Organization
Organization Name:CREED S HAYMOND DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CREED
Authorized Official - Middle Name:S
Authorized Official - Last Name:HAYMOND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-576-0077
Mailing Address - Street 1:1434 EAST 9400 SO
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093
Mailing Address - Country:US
Mailing Address - Phone:801-576-0077
Mailing Address - Fax:801-495-1837
Practice Address - Street 1:1434 E 9400 SOUTH
Practice Address - Street 2:SUITE 102
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84093
Practice Address - Country:US
Practice Address - Phone:801-576-0077
Practice Address - Fax:801-495-1837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-03
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT145378204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT528027009017Medicaid