Provider Demographics
NPI:1487803367
Name:ANDREA G. HAYDON, DMD PLLC
Entity type:Organization
Organization Name:ANDREA G. HAYDON, DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER OF BUSINESS
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:GOATLEY
Authorized Official - Last Name:HAYDON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-348-0908
Mailing Address - Street 1:202 W. STEPHEN FOSTER AVENUE
Mailing Address - Street 2:SUITE E
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004
Mailing Address - Country:US
Mailing Address - Phone:502-348-0908
Mailing Address - Fax:502-348-0948
Practice Address - Street 1:202 W. STEPHEN FOSTER AVENUE
Practice Address - Street 2:SUITE E
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004
Practice Address - Country:US
Practice Address - Phone:502-348-0908
Practice Address - Fax:502-348-0948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6676122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty