Healthcare Provider Details

I. General information

NPI: 1942348172
Provider Name (Legal Business Name): ELIZABETH JEAN HAYNES D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7833 WALKER DR SUITE 10
GREENBELT MD
20770-3211
US

IV. Provider business mailing address

10301 TWIN KNOLL WAY
UPPER MARLBORO MD
20772-6650
US

V. Phone/Fax

Practice location:
  • Phone: 301-220-1900
  • Fax: 301-474-0433
Mailing address:
  • Phone: 301-574-3396
  • Fax: 301-574-3396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number10904
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: