Provider Demographics
NPI:1073248407
Name:LEO A HAYDT IV DMD V, PLLC
Entity type:Organization
Organization Name:LEO A HAYDT IV DMD V, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:ALOYSIOUS
Authorized Official - Last Name:HAYDT
Authorized Official - Suffix:IV
Authorized Official - Credentials:DMD
Authorized Official - Phone:919-760-6710
Mailing Address - Street 1:208 N ARENDELL AVE.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ZEBULON
Mailing Address - State:NC
Mailing Address - Zip Code:27597
Mailing Address - Country:US
Mailing Address - Phone:919-760-6710
Mailing Address - Fax:919-869-2999
Practice Address - Street 1:208 N. ARENDELL AVE.
Practice Address - Street 2:SUITE 101
Practice Address - City:ZEBULON
Practice Address - State:NC
Practice Address - Zip Code:27597
Practice Address - Country:US
Practice Address - Phone:919-760-6710
Practice Address - Fax:919-869-2999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty