Healthcare Provider Details

I. General information

NPI: 1518443738
Provider Name (Legal Business Name): DEANDRA HAYES DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2018
Last Update Date: 04/07/2020
Certification Date: 04/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 S 41ST ST E
MUSKOGEE OK
74403-6253
US

IV. Provider business mailing address

817 S LAKE REGION RD
HULBERT OK
74441-2698
US

V. Phone/Fax

Practice location:
  • Phone: 918-781-6580
  • Fax:
Mailing address:
  • Phone: 918-931-9582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7083
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number7083
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: