Provider Demographics
NPI:1205043460
Name:HAYNES, KEVIN P (DDS)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:P
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 1:3301 STERLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-2521
Mailing Address - Country:US
Mailing Address - Phone:318-325-3254
Mailing Address - Fax:318-398-9444
Practice Address - Street 1:3301 STERLINGTON RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-2521
Practice Address - Country:US
Practice Address - Phone:318-325-3254
Practice Address - Fax:318-398-9444
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4486122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist