Hayward Dental Group, P.S.C.

Primary specialty

DentistTaxonomy code 122300000X

License

8389 Issued in KY

Legal business name

HAYWARD DENTAL GROUP, P.S.C.

Doing business as

Fourth Street Dental

Practice address

1018 S 4TH St
Suite 250
Louisville, KY 40203-3221

Phone

(502) 585-4320

Fax

(502) 585-4355

NPI assigned

Apr 29, 2008

Last updated

Apr 29, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Theresa C. Hayward, D.M.D.

Title

President

Phone

(502) 585-4320

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Fourth Street Dental Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ellen Ann Harpster, D.M.D.

  • General Practice Dentistry
  • Louisville, KY
  • NPI 1023098241
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1209427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209427200000",
    "number": "1942475934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1018 S 4TH ST",
            "address_2": "SUITE 250",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402033221",
            "telephone_number": "502-585-4320",
            "fax_number": "502-585-4355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1018 S 4TH ST",
            "address_2": "SUITE 250",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402033221",
            "telephone_number": "502-585-4320",
            "fax_number": "502-585-4355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAYWARD DENTAL GROUP, P.S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-29",
        "last_updated": "2008-04-29",
        "status": "A",
        "authorized_official_last_name": "HAYWARD",
        "authorized_official_first_name": "THERESA",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "502-585-4320",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "KY",
            "license": "8389",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100011840",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fourth Street Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Terri L. Haynes
• Crista Hays, MD
• Willa Kathryn Hays, MS, BCBA, LBA
• Kenneth Irwin Haysley, LMFT
• Morgan Haysley, M.S., CCC-SLP
• Whitney Haywood, BS
• Avery Hazard
• James Taylor Hazard, D.M.D.
• Antony Hazel, M.D.
• Monique Hazel

• Dentist in Louisville, KY
• Providers in Louisville, KY by specialty
• Dentist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.