MEDICARE: DR. RICHARD A. HAIMES DDS

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

General Provider Information

NPI Number	:	1588706246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD A. HAIMES DDS

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	12/26/2007

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