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General NPI Number Information
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NPI Number | 1396429890
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Entity Type | Individual
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Provider Name | CAMILLE IVERIS HAYNES
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Gender | Female
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Dates
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Enumeration Date | 06/14/2023
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Last Update Date | 08/15/2024
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Provider Practice Location Address
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Address Line | 11682 US 1 STE 60
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City | NORTH PALM BEACH
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State | FL
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Zip | 33408-3035
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Country | US
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Telephone | 561-624-2047
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Fax |
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Provider Business Mailing Address
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Address Line | 2801 SW 116TH AVE
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City | DAVIE
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State | FL
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Zip | 33330-1418
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Country | US
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Telephone | 954-918-5086
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 28289
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License Number State | FL
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