MEDICARE: DR. WENONAH HAIRE D.M.D.

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	1223G0001X	General Practice Dentistry	002268	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679618599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WENONAH HAIRE D.M.D.

Provider Business Mailing Address
First Line	:	1387 MEADOW LAKES RD
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-9098
Country	:	US
Telephone Number	:	803-328-8037
Fax Number	:

Provider Business Practice Location Address
First Line	:	611 E MAIN ST
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29730-5324
Country	:	US
Telephone Number	:	803-324-5214
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	07/09/2007

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