Fourth Street Dental

LBN: Hayward Dental Group, P.S.C.
Fourth Street Dental is an health care organization with primary practice located at 1018 S 4Th St Suite 250, Louisville KY 40203-3221. The organization recently has only one registered license in Dental Providers / Dentist, which is considered as the primary health care specialty. Hayward Dental Group, P.S.C. can be contacted via phone (502) 585-4320, or through Hayward, Theresa C. via phone (502) 585-4320.

Contact Information

Primary practice address
1018 S 4Th St Suite 250 Louisville KY 40203-3221
Phone: (502) 585-4320
Fax: (502) 585-4355
Website:
Map and Directions
Authorized official contact:
Name: Hayward, Theresa C. Doctor of Dental Medicine (DMD)
Phone: (502) 585-4320

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dentist 122300000X 8389 Kentucky

Profile Details

NPI number 1942475934
LBN Legal business name Hayward Dental Group, P.S.C.
DBA Doing business as Fourth Street Dental
Authorized official Hayward, Theresa C. Doctor of Dental Medicine (DMD)
Entity Organization
Organization subpart 1 No
Enumeration date Apr 29th, 2008
Last updated Apr 29th, 2008 - about 18 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1942475934 NPPES
Kentucky MEDICAID 7100011840

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