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General NPI Number Information
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NPI Number | 1679665525
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Entity Type | Individual
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Provider Name | MARK B HAIMS D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 06/26/2022
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Provider Practice Location Address
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Address Line | 79 RETREAT AVE
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City | HARTFORD
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State | CT
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Zip | 06106-2527
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Country | US
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Telephone | 860-966-8616
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Fax |
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Provider Business Mailing Address
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Address Line | 23 FOREST HILLS DR
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City | WEST HARTFORD
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State | CT
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Zip | 06117-1112
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Country | US
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Telephone | 860-232-0828
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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 | 006621
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License Number State | CT
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