Healthcare Provider Details

I. General information

NPI: 1659557411
Provider Name (Legal Business Name): DAVID PETER HAYWARD D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2008
Last Update Date: 01/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4355 SUWANEE DAM RD.
SUWANEE GA
30024-6705
US

IV. Provider business mailing address

4355 SUWANEE DAM RD
SUWANEE GA
30024-6707
US

V. Phone/Fax

Practice location:
  • Phone: 770-614-7300
  • Fax: 770-614-7911
Mailing address:
  • Phone: 770-614-7300
  • Fax: 770-614-7911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN008871
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: