Provider Demographics
NPI:1528674116
Name:HAYNIE, ALLISON (DDS)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:HAYNIE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:HAYNIE
Other - Last Name:KERST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1914 E 70TH ST STE H
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5312
Mailing Address - Country:US
Mailing Address - Phone:318-797-8833
Mailing Address - Fax:
Practice Address - Street 1:1914 E 70TH ST STE H
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5312
Practice Address - Country:US
Practice Address - Phone:318-797-8833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA71321223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics