Provider Demographics
NPI:1659533479
Name:HAYNIE, BRACY C (DDS)
Entity Type:Individual
Prefix:MR
First Name:BRACY
Middle Name:C
Last Name:HAYNIE
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 1:102 HARTMAN DR
Mailing Address - Street 2:SUITE H
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-2569
Mailing Address - Country:US
Mailing Address - Phone:615-609-1319
Mailing Address - Fax:615-453-6100
Practice Address - Street 1:102 HARTMAN DR
Practice Address - Street 2:SUITE H
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-2569
Practice Address - Country:US
Practice Address - Phone:615-609-1319
Practice Address - Fax:615-453-6100
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8836122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist