Provider Demographics
NPI:1366782229
Name:HAIMES, SCOTT IAN (DMD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:IAN
Last Name:HAIMES
Suffix:
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 1:1901 N OLDEN AVENUE EXT
Mailing Address - Street 2:SUITE-28A
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-2111
Mailing Address - Country:US
Mailing Address - Phone:609-882-2294
Mailing Address - Fax:609-882-8805
Practice Address - Street 1:1901 N OLDEN AVENUE EXT
Practice Address - Street 2:SUITE-28A
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08618-2111
Practice Address - Country:US
Practice Address - Phone:609-882-2294
Practice Address - Fax:609-882-8805
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ20040122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist