Provider Demographics
NPI:1912161605
Name:HAYNES, DAVID SCOTT (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SCOTT
Last Name:HAYNES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 MAKALOA ST
Mailing Address - Street 2:SUITE 725
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-3237
Mailing Address - Country:US
Mailing Address - Phone:808-973-3747
Mailing Address - Fax:808-973-3757
Practice Address - Street 1:1580 MAKALOA ST
Practice Address - Street 2:SUITE 725
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3237
Practice Address - Country:US
Practice Address - Phone:808-973-3747
Practice Address - Fax:808-973-3757
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI19161223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI52682403Medicaid
HIU82367Medicare UPIN
HI100788Medicare PIN