Provider Demographics
NPI:1225216138
Name:HAIMES & WEISBERG FAMILY DENTISTRY PA
Entity Type:Organization
Organization Name:HAIMES & WEISBERG FAMILY DENTISTRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:IAN
Authorized Official - Last Name:HAIMES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-882-2294
Mailing Address - Street 1:1901 NORTH OLDEN AVENUE EXT
Mailing Address - Street 2:SUITE 28A
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-2111
Mailing Address - Country:US
Mailing Address - Phone:609-882-2294
Mailing Address - Fax:609-882-8805
Practice Address - Street 1:1901 NORTH OLDEN AVENUE EXT
Practice Address - Street 2:SUITE 28A
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08618-2111
Practice Address - Country:US
Practice Address - Phone:609-882-2294
Practice Address - Fax:609-882-8805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02004000122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty