Provider Demographics
NPI:1962840850
Name:HAYNIE, KAREN LEIGH (DDS)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:LEIGH
Last Name:HAYNIE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7217 GILBERT DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-4730
Mailing Address - Country:US
Mailing Address - Phone:318-469-6046
Mailing Address - Fax:
Practice Address - Street 1:385 BERT KOUNS INDUSTRIAL LOOP
Practice Address - Street 2:SUITE 700
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-8158
Practice Address - Country:US
Practice Address - Phone:318-688-9330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA63811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice