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General NPI Number Information
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NPI Number | 1548568124
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Entity Type | Organization
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Legal Business Name | HAYDEN RUN DENTISTRY
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Dates
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Enumeration Date | 03/07/2011
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Last Update Date | 03/07/2011
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Provider Practice Location Address
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Address Line | 4986 COSGRAY RD
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City | DUBLIN
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State | OH
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Zip | 43016-8337
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Country | US
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Telephone | 614-534-0688
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Fax | 614-534-0699
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Provider Business Mailing Address
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Address Line | 4986 COSGRAY RD
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City | DUBLIN
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State | OH
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Zip | 43016-8337
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Country | US
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Telephone | 614-534-0688
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Fax | 614-534-0699
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | DR. KIMBERLY DAWN MICHALAK
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Credential | DDS
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Telephone | 614-534-0688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 30-022574
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License Number State | OH
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