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General NPI Number Information
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NPI Number | 1417014226
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Entity Type | Organization
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Legal Business Name | BRYAN D. HAYNES DDS INC
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 03/09/2016
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Provider Practice Location Address
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Address Line | 1249 POWELL ST
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City | EMERYVILLE
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State | CA
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Zip | 94608-2604
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Country | US
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Telephone | 510-652-3070
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Fax | 510-652-0387
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Provider Business Mailing Address
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Address Line | 1249 POWELL ST
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City | EMERYVILLE
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State | CA
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Zip | 94608-2604
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Country | US
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Telephone | 510-652-3070
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Fax | 510-652-0387
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Authorized Official
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Title or Position | DENTIST
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Name | DR. BRYAN D. HAYNES
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Credential |
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Telephone | 510-652-3070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 031066
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License Number State | CA
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