Provider Demographics
NPI:1184635187
Name:MILBURN S. HAYNES, D.D.S., P.A.
Entity Type:Organization
Organization Name:MILBURN S. HAYNES, D.D.S., P.A.
Other - Org Name:PLEASANT GROVE FAMILY DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MILBURN
Authorized Official - Middle Name:SIDNEY
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PA
Authorized Official - Phone:903-838-9700
Mailing Address - Street 1:4330 MCKNIGHT RD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-0923
Mailing Address - Country:US
Mailing Address - Phone:903-838-9700
Mailing Address - Fax:
Practice Address - Street 1:4330 MCKNIGHT RD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-0923
Practice Address - Country:US
Practice Address - Phone:903-838-9700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX196021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty