Provider Demographics
NPI:1972169894
Name:HAINE, BYANKA MALEYNA (DDS)
Entity Type:Individual
Prefix:
First Name:BYANKA
Middle Name:MALEYNA
Last Name:HAINE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3605 BRYAN ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-6112
Mailing Address - Country:US
Mailing Address - Phone:817-658-0900
Mailing Address - Fax:
Practice Address - Street 1:3310 LIVE OAK ST STE 200
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-6148
Practice Address - Country:US
Practice Address - Phone:214-827-1305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-15
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX36317122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program