Healthcare Provider Details

I. General information

NPI: 1649271198
Provider Name (Legal Business Name): DAVID J HAYUTIN DDS PROF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5055 E KENTUCKY AVE
DENVER CO
80246
US

IV. Provider business mailing address

5055 E KENTUCKY AVE
DENVER CO
80246
US

V. Phone/Fax

Practice location:
  • Phone: 303-757-8844
  • Fax: 303-759-0994
Mailing address:
  • Phone: 303-757-8844
  • Fax: 303-759-0994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number915
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number6181
License Number StateCO

VIII. Authorized Official

Name: DR. DAVID JOEL HAYUTIN
Title or Position: MANAGER
Credential: DDS
Phone: 303-757-8844