Individual
LISA D. HAINES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.M.D.
Contact information
Practice address
11001 MANCHESTER RD, KIRKWOOD, MO 63122-1243
(314) 966-7778
(314) 909-1579
Mailing address
11001 MANCHESTER RD, KIRKWOOD, MO 63122-1243
(314) 966-7778
(314) 909-1579
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2003016572
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20-1467596
TAX ID
MO
Enumeration date
05/21/2007
Last updated
07/08/2007
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