Healthcare Provider Details

I. General information

NPI: 1487587762
Provider Name (Legal Business Name): HAYDEN JOHNSON DDS
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4608 S HARVARD AVE STE B
TULSA OK
74135-2913
US

IV. Provider business mailing address

4608 S HARVARD AVE STE B
TULSA OK
74135-2913
US

V. Phone/Fax

Practice location:
  • Phone: 918-749-4621
  • Fax:
Mailing address:
  • Phone: 918-749-4621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8236
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: