=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255224432
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAYES PREMPEH KNOCKUM AND ASSOCIATES HAMPSTEAD, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/29/2025
-----------------------------------------------------
Last Update Date | 05/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14057 HIGHWAY 17 SUITE 210
-----------------------------------------------------
City | HAMPSTEAD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28443
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-406-8552
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2748 FENNELL TOWN RD
-----------------------------------------------------
City | ROCKY POINT
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28457-8786
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-452-1546
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. CRYSTAL HAYES PREMPEH
-----------------------------------------------------
Credential | DDS MPH
-----------------------------------------------------
Telephone | 919-452-1546
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------