MEDICARE: NICOLE HAYDT DDS, MS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1043166077
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NICOLE HAYDT DDS, MS INC

Provider Business Mailing Address
First Line	:	2668 N TUSTIN ST
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92865-2438
Country	:	US
Telephone Number	:	805-390-9438
Fax Number	:

Provider Business Practice Location Address
First Line	:	2668 N TUSTIN ST
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92865-2438
Country	:	US
Telephone Number	:	805-390-9438
Fax Number	:

Authorized Official
Title or Position	:	ORTHODONTIST
Name	:	DR. NICOLE HAYDT
Credential	:	DDS, MS
Telephone Number	:	805-390-9438

Provider Enumeration Date	:	03/10/2026
Last Update Date	:	03/10/2026

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