Provider Demographics
NPI:1144489121
Name:RICHARD A HAIMES DDS, PC
Entity type:Organization
Organization Name:RICHARD A HAIMES DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAIMES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:631-665-3131
Mailing Address - Street 1:1991 UNION BLVD
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-7936
Mailing Address - Country:US
Mailing Address - Phone:631-665-3131
Mailing Address - Fax:631-665-0566
Practice Address - Street 1:1991 UNION BLVD
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-7936
Practice Address - Country:US
Practice Address - Phone:631-665-3131
Practice Address - Fax:631-665-0566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0319961223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5744OtherFIDELIS