Provider Demographics
NPI:1386791580
Name:HAYHURST, DAVID L (DDS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:HAYHURST
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 1:550 W VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-1614
Mailing Address - Country:US
Mailing Address - Phone:812-425-5194
Mailing Address - Fax:812-426-9984
Practice Address - Street 1:550 W VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1614
Practice Address - Country:US
Practice Address - Phone:812-425-5194
Practice Address - Fax:812-426-9984
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009019204E00000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100246120Medicaid
INU63654Medicare UPIN
IN100246120Medicaid