Healthcare Provider Details

I. General information

NPI: 1679676134
Provider Name (Legal Business Name): HAYES DENTAL ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 07/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3073 GEORGE WASHINGTON HWY
HAYES VA
23072
US

IV. Provider business mailing address

PO BOX 665
HAYES VA
23072
US

V. Phone/Fax

Practice location:
  • Phone: 804-642-2212
  • Fax: 804-642-9026
Mailing address:
  • Phone: 804-642-2212
  • Fax: 804-642-9026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number0401411190
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number0401008284
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6140
License Number StateVA

VIII. Authorized Official

Name: DR. ROBERT W. GEORGE
Title or Position: OWNER DENTIST
Credential: DDS
Phone: 804-642-2212