Active NPI
Kevin L Haywood Sr., RDA
- Dental Assistant
- Fort Worth, TX
National Provider Identifier
1245513209
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Assistant
- License
- 25953
- Practice address
- 3740 S University Dr
Suite 201
Fort Worth, TX 76109-3700 - Phone
- (817) 614-0794
- Fax
- (817) 367-7714
- NPI assigned
- Sep 26, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Assistant | 126800000X | 25953 | TX | Primary |
Addresses
Primary practice location
3740 S University Dr
Suite 201
Fort Worth, TX 76109-3700
Mailing address
8701 Regal Royale Dr
Fort Worth, TX 76108-7948
Phone (817) 614-0794
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25953 | TX | MD | Dental Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| National Dental Services- NDS Dental | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
dba NDS Dental
- General Practice Dentistry
- Fort Worth, TX
- NPI 1609274026
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1316995200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1316995200000",
"number": "1245513209",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8701 REGAL ROYALE DR",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761087948",
"telephone_number": "817-614-0794"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3740 S UNIVERSITY DR",
"address_2": "SUITE 201",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761093700",
"telephone_number": "817-614-0794",
"fax_number": "817-367-7714"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAYWOOD",
"first_name": "KEVIN",
"middle_name": "L",
"name_prefix": "Mr.",
"name_suffix": "Sr.",
"credential": "RDA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-09-26",
"last_updated": "2011-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "126800000X",
"taxonomy_group": "",
"desc": "Dental Assistant",
"state": "TX",
"license": "25953",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.