MEDICARE: VICKI L HAINES RDH

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	124Q00000X	Dental Hygienist	13005983A	IN

General Provider Information

NPI Number	:	1871346544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICKI L HAINES RDH

Provider Business Mailing Address
First Line	:	1359 S RANDOLPH ST
Second Line	:
City	:	GARRETT
State	:	IN
Zip	:	46738-1970
Country	:	US
Telephone Number	:	260-357-0077
Fax Number	:

Provider Business Practice Location Address
First Line	:	1359 S RANDOLPH ST
Second Line	:
City	:	GARRETT
State	:	IN
Zip	:	46738-1970
Country	:	US
Telephone Number	:	260-357-0077
Fax Number	:

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

Provider Enumeration Date	:	04/10/2024
Last Update Date	:	04/10/2024

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Directions to “ VICKI L HAINES RDH” Practice Location

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