Provider Demographics
NPI:1396429890
Name:HAYNES, CAMILLE IVERIS
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:IVERIS
Last Name:HAYNES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 SW 116TH AVE
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33330-1418
Mailing Address - Country:US
Mailing Address - Phone:954-918-5086
Mailing Address - Fax:
Practice Address - Street 1:11682 US 1 STE 60
Practice Address - Street 2:
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-3035
Practice Address - Country:US
Practice Address - Phone:561-624-2047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL282891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice