Provider Demographics
NPI:1306073119
Name:HAYNES, MICHELLE OSIF (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:OSIF
Last Name:HAYNES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9461 S UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80126-4976
Mailing Address - Country:US
Mailing Address - Phone:303-470-1377
Mailing Address - Fax:
Practice Address - Street 1:9461 S UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80126-4976
Practice Address - Country:US
Practice Address - Phone:303-470-1377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO99131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice