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General NPI Number Information
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NPI Number | 1144714247
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Entity Type | Individual
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Provider Name | GREGORY HAINES JR. DMD
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Gender | Male
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Dates
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Enumeration Date | 06/21/2018
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 1104 COOPER ST
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City | DEPTFORD
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State | NJ
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Zip | 08096-3012
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Country | US
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Telephone | 856-845-1200
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Fax |
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Provider Business Mailing Address
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Address Line | 323 BEECH AVE
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City | WOODBURY HEIGHTS
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State | NJ
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Zip | 08097-1316
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Country | US
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Telephone | 609-330-3804
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DI02717700
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License Number State | NJ
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