Healthcare Provider Details

I. General information

NPI: 1902893423
Provider Name (Legal Business Name): LYNN FRANCIS HAINES DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 MDG UNIT 3215
APO AE
09094
DE

IV. Provider business mailing address

435 MDG UNIT 3215
APO AE
09094
DE

V. Phone/Fax

Practice location:
  • Phone: 01149637146
  • Fax:
Mailing address:
  • Phone: 01149637146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number30-01-5439
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: