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General NPI Number Information
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NPI Number | 1144489121
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Entity Type | Organization
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Legal Business Name | RICHARD A HAIMES DDS, PC
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Dates
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Enumeration Date | 06/05/2008
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Last Update Date | 06/05/2008
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Provider Practice Location Address
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Address Line | 1991 UNION BLVD
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City | BAY SHORE
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State | NY
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Zip | 11706-7936
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Country | US
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Telephone | 631-665-3131
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Fax | 631-665-0566
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Provider Business Mailing Address
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Address Line | 1991 UNION BLVD
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City | BAY SHORE
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State | NY
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Zip | 11706-7936
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Country | US
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Telephone | 631-665-3131
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Fax | 631-665-0566
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Authorized Official
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Title or Position | ORAL SURGEON
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Name | DR. RICHARD A HAIMES
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Credential | DDS
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Telephone | 631-665-3131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 031996
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License Number State | NY
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