MEDICARE: RICHARD A HAIMES DDS, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	031996	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5744	OTHER	NY	FIDELIS

General Provider Information

NPI Number	:	1144489121
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD A HAIMES DDS, PC

Provider Business Mailing Address
First Line	:	1991 UNION BLVD
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-7936
Country	:	US
Telephone Number	:	631-665-3131
Fax Number	:	631-665-0566

Provider Business Practice Location Address
First Line	:	1991 UNION BLVD
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-7936
Country	:	US
Telephone Number	:	631-665-3131
Fax Number	:	631-665-0566

Authorized Official
Title or Position	:	ORAL SURGEON
Name	:	DR. RICHARD A HAIMES
Credential	:	DDS
Telephone Number	:	631-665-3131

Provider Enumeration Date	:	06/05/2008
Last Update Date	:	06/05/2008

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