Provider Demographics
NPI:1174786206
Name:HAYES, ERIC WALLACE (DDS)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:WALLACE
Last Name:HAYES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:01105 PLANK RD.
Mailing Address - Street 2:SUITE C
Mailing Address - City:CLINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70722
Mailing Address - Country:US
Mailing Address - Phone:225-683-9000
Mailing Address - Fax:225-683-7000
Practice Address - Street 1:10105 PLANK RD.
Practice Address - Street 2:SUITE C
Practice Address - City:CLINTON
Practice Address - State:LA
Practice Address - Zip Code:70722
Practice Address - Country:US
Practice Address - Phone:225-683-9000
Practice Address - Fax:225-683-7000
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5921122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS347308OtherLICENSE
LA5921OtherSTATE BOARD OF DENTISTRY