Provider Demographics
NPI:1306572250
Name:LEO A HAYDT IV DMD IV, PLLC
Entity type:Organization
Organization Name:LEO A HAYDT IV DMD IV, 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:919-747-7888
Mailing Address - Street 1:3421 OLYMPIA DR.
Mailing Address - Street 2:SUITE 201
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603
Mailing Address - Country:US
Mailing Address - Phone:919-747-7888
Mailing Address - Fax:919-516-0589
Practice Address - Street 1:3421 OLYMPIA DR.
Practice Address - Street 2:SUITE 201
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603
Practice Address - Country:US
Practice Address - Phone:919-747-7888
Practice Address - Fax:919-516-0589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty