Provider Demographics
NPI:1548472970
Name:SLACK-HAYNES, MONICA ALVYRA (DDS11)
Entity type:Individual
Prefix:DR
First Name:MONICA
Middle Name:ALVYRA
Last Name:SLACK-HAYNES
Suffix:
Gender:F
Credentials:DDS11
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 KIMBERLY AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-2411
Mailing Address - Country:US
Mailing Address - Phone:203-865-7307
Mailing Address - Fax:203-865-7307
Practice Address - Street 1:7 KIMBERLY AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-2411
Practice Address - Country:US
Practice Address - Phone:203-865-7307
Practice Address - Fax:203-865-7307
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT57081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice