Healthcare Provider Details

I. General information

NPI: 1588706246
Provider Name (Legal Business Name): RICHARD A. HAIMES DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: RICHARD A HAIMES DDS

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 12/26/2007
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:
Title or Position:
Credential:
Phone: