Provider Demographics
NPI:1083225833
Name:HAYNIE PREMIER PROVIDERS PC
Entity Type:Organization
Organization Name:HAYNIE PREMIER PROVIDERS PC
Other - Org Name:TMJ AND SLEEP THERAPY CENTRE OF THE GORGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYNIE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:541-386-2999
Mailing Address - Street 1:PO BOX 728
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-0023
Mailing Address - Country:US
Mailing Address - Phone:541-386-2999
Mailing Address - Fax:541-833-0724
Practice Address - Street 1:307 E SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-2358
Practice Address - Country:US
Practice Address - Phone:541-386-2999
Practice Address - Fax:541-386-3726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty