Provider Demographics
NPI:1144714247
Name:HAINES, GREGORY JR (DMD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:HAINES
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 BEECH AVE
Mailing Address - Street 2:
Mailing Address - City:WOODBURY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08097-1316
Mailing Address - Country:US
Mailing Address - Phone:609-330-3804
Mailing Address - Fax:
Practice Address - Street 1:1104 COOPER ST
Practice Address - Street 2:
Practice Address - City:DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08096-3012
Practice Address - Country:US
Practice Address - Phone:856-845-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02717700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist