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General NPI Number Information
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NPI Number | 1548607633
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Entity Type | Organization
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Legal Business Name | J.R. HAYNIE DDS PC
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Dates
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Enumeration Date | 05/29/2013
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Last Update Date | 05/29/2013
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Provider Practice Location Address
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Address Line | 980 W IRONWOOD DR STE 301
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2668
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Country | US
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Telephone | 208-664-0844
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Fax | 208-664-9682
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Provider Business Mailing Address
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Address Line | 980 W IRONWOOD DR STE 301
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2668
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Country | US
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Telephone | 208-664-0844
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Fax | 208-664-9682
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN ROBERT HAYNIE
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Credential | DDS
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Telephone | 614-460-1181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | N-13145
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License Number State | ID
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