Healthcare Provider Details

I. General information

NPI: 1396872743
Provider Name (Legal Business Name): MICHAEL J. HAIGHT SR. D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 05/19/2022
Certification Date: 05/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1113 GENERAL JACKSON DRIVE
HAMMOND LA
70401-1643
US

IV. Provider business mailing address

1113 GENERAL JACKSON DRIVE
HAMMOND LA
70401-1643
US

V. Phone/Fax

Practice location:
  • Phone: 985-345-1488
  • Fax: 985-345-1451
Mailing address:
  • Phone: 985-345-1488
  • Fax: 985-345-1451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2287
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2287
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: