Provider Demographics
NPI:1487727962
Name:DAVID S HAYNES DMD INC
Entity type:Organization
Organization Name:DAVID S HAYNES DMD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:808-454-2565
Mailing Address - Street 1:850 KAMEHAMEHA HWY
Mailing Address - Street 2:SUITE 155
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-2657
Mailing Address - Country:US
Mailing Address - Phone:808-454-2565
Mailing Address - Fax:808-454-2569
Practice Address - Street 1:850 KAMEHAMEHA HWY
Practice Address - Street 2:SUITE 155
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-2657
Practice Address - Country:US
Practice Address - Phone:808-454-2565
Practice Address - Fax:808-454-2569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT1916122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI52682402Medicaid
100788Medicare ID - Type Unspecified
HI52682402Medicaid