MEDICARE: DR. CHARLES A HAYDEL DDS

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	122300000X	Dentist	3967	LA

General Provider Information

NPI Number	:	1225096548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES A HAYDEL DDS

Provider Business Mailing Address
First Line	:	8635 HWY 23
Second Line	:
City	:	BELLE CHASSE
State	:	LA
Zip	:	70037
Country	:	US
Telephone Number	:	504-394-7456
Fax Number	:	504-394-7457

Provider Business Practice Location Address
First Line	:	8635 HWY 23
Second Line	:
City	:	BELLE CHASSE
State	:	LA
Zip	:	70037
Country	:	US
Telephone Number	:	504-394-7456
Fax Number	:	504-394-7457

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	07/08/2007

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