Provider Demographics
NPI:1164502886
Name:HAYNES, TERRENCE WAYNE (DDS)
Entity Type:Individual
Prefix:
First Name:TERRENCE
Middle Name:WAYNE
Last Name:HAYNES
Suffix:
Gender:M
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:PO BOX 430150
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48343-0150
Mailing Address - Country:US
Mailing Address - Phone:248-724-7434
Mailing Address - Fax:248-724-7447
Practice Address - Street 1:861 JOSLYN
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48340-2919
Practice Address - Country:US
Practice Address - Phone:248-758-1231
Practice Address - Fax:248-282-7810
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI152731223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice