Individual
AMANDA MARIE HAINES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
122 GRANT ST, NILES, MI 49120-2281
(269) 262-4364
(269) 340-5981
Mailing address
122 GRANT ST, NILES, MI 49120-2281
(269) 262-4364
(269) 340-5981
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
2902016264
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1447701008
—
MI
Enumeration date
01/03/2019
Last updated
01/03/2019
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