Provider Demographics
NPI:1720130024
Name:HAINES, LORI A (DMD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:A
Last Name:HAINES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27
Mailing Address - Street 2:112 FAIRFIELD HILL ROAD
Mailing Address - City:BLOOMFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:40008-0027
Mailing Address - Country:US
Mailing Address - Phone:502-252-5158
Mailing Address - Fax:502-252-7857
Practice Address - Street 1:112 FAIRFIELD HILL
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:KY
Practice Address - Zip Code:40008
Practice Address - Country:US
Practice Address - Phone:502-507-7181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY67921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice