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General NPI Number Information
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NPI Number | 1184751463
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Entity Type | Individual
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Provider Name | LEE TATE HAYMON DDS
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Gender | Male
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 06/22/2023
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Provider Practice Location Address
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Address Line | 581 FARRINGDOM ST
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City | LUMBERTON
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State | NC
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Zip | 28358-2614
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Country | US
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Telephone | 910-738-3913
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Fax | 910-738-3994
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Provider Business Mailing Address
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Address Line | 104 4TH ST
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City | BLADENBORO
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State | NC
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Zip | 28320-9407
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Country | US
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Telephone | 910-863-2733
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 6038
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6038
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License Number State | NC
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