Provider Demographics
NPI:1962618074
Name:SUSIE S. HAYDEN D.D.S., PA
Entity type:Organization
Organization Name:SUSIE S. HAYDEN D.D.S., PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:HAYDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-491-4141
Mailing Address - Street 1:20322 HUEBNER RD
Mailing Address - Street 2:SUITE #103
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258
Mailing Address - Country:US
Mailing Address - Phone:210-491-4141
Mailing Address - Fax:210-494-4025
Practice Address - Street 1:20322 HUEBNER RD
Practice Address - Street 2:SUITE #103
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258
Practice Address - Country:US
Practice Address - Phone:210-491-4141
Practice Address - Fax:210-494-4025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX168391223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty