Provider Demographics
NPI: | 1154153989 |
---|---|
Name: | HAYNER DENTAL LLC |
Entity type: | Organization |
Organization Name: | HAYNER DENTAL LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER - DENTIST |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | CHRISTOPHER |
Authorized Official - Middle Name: | PAUL |
Authorized Official - Last Name: | HAYNER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DMD |
Authorized Official - Phone: | 412-281-3955 |
Mailing Address - Street 1: | 129 28TH ST |
Mailing Address - Street 2: | |
Mailing Address - City: | PITTSBURGH |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 15222-4797 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 412-281-3955 |
Mailing Address - Fax: | 412-281-4880 |
Practice Address - Street 1: | 129 28TH ST |
Practice Address - Street 2: | |
Practice Address - City: | PITTSBURGH |
Practice Address - State: | PA |
Practice Address - Zip Code: | 15222-4797 |
Practice Address - Country: | US |
Practice Address - Phone: | 412-281-3955 |
Practice Address - Fax: | 412-281-4880 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2024-08-19 |
Last Update Date: | 2024-08-19 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1223G0001X | Dental Providers | Dentist | General Practice | Group - Multi-Specialty |
No | 1223E0200X | Dental Providers | Dentist | Endodontics | Group - Multi-Specialty |