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General NPI Number Information
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NPI Number | 1659985232
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Entity Type | Individual
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Provider Name | NICOLE HAYDT DDS
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Gender | Female
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Dates
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Enumeration Date | 09/01/2020
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Last Update Date | 05/03/2022
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Provider Practice Location Address
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Address Line | 39872 LOS ALAMOS RD STE A1
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City | MURRIETA
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State | CA
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Zip | 92562-5871
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Country | US
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Telephone | 951-200-3339
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Fax |
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Provider Business Mailing Address
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Address Line | 364 W LINDEN DR
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City | ORANGE
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State | CA
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Zip | 92865-5000
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Country | US
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Telephone | 805-390-9438
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DEN.00204298
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 107346
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License Number State | CA
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