Healthcare Provider Details

I. General information

NPI: 1144489121
Provider Name (Legal Business Name): RICHARD A HAIMES DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1991 UNION BLVD
BAY SHORE NY
11706-7936
US

IV. Provider business mailing address

1991 UNION BLVD
BAY SHORE NY
11706-7936
US

V. Phone/Fax

Practice location:
  • Phone: 631-665-3131
  • Fax: 631-665-0566
Mailing address:
  • Phone: 631-665-3131
  • Fax: 631-665-0566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number031996
License Number StateNY

VIII. Authorized Official

Name: DR. RICHARD A HAIMES
Title or Position: ORAL SURGEON
Credential: DDS
Phone: 631-665-3131