Organization
J.R. HAYNIE DDS PC
Active
Other names
Lakeside Oral Surgery & Dental Implants
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN ROBERT HAYNIE DDS (OWNER)
(614) 460-1181
Entity
Organization
Contact information
Practice address
980 W IRONWOOD DR STE 301, COEUR D ALENE, ID 83814-2668
(208) 664-0844
(208) 664-9682
Mailing address
980 W IRONWOOD DR STE 301, COEUR D ALENE, ID 83814-2668
(208) 664-0844
(208) 664-9682
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
N-13145
ID
Other
Enumeration date
05/29/2013
Last updated
05/29/2013
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