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General NPI Number Information
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NPI Number | 1699945741
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Entity Type | Organization
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Legal Business Name | L TATE HAYMON DDS
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Dates
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Enumeration Date | 03/05/2008
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Last Update Date | 03/05/2008
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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 | 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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Authorized Official
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Title or Position | OWNER
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Name | LEE TATE HAYMON
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Credential | DDS
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Telephone | 910-738-3913
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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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