Provider Demographics
NPI:1396883294
Name:HAYES, STAN (DMD)
Entity type:Individual
Prefix:
First Name:STAN
Middle Name:
Last Name:HAYES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 200
Mailing Address - Street 2:
Mailing Address - City:EASTERN
Mailing Address - State:KY
Mailing Address - Zip Code:41622
Mailing Address - Country:US
Mailing Address - Phone:606-358-4157
Mailing Address - Fax:606-358-4157
Practice Address - Street 1:292 HIGHWAY 550
Practice Address - Street 2:
Practice Address - City:EASTERN
Practice Address - State:KY
Practice Address - Zip Code:41622
Practice Address - Country:US
Practice Address - Phone:606-358-4157
Practice Address - Fax:606-358-4157
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5992122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60059920Medicaid