Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DS039125 | PA |
Y | 1223D0004X | Dentist Anesthesiologist | 8587 | SC |
NPI | 1538422662 |
---|---|
Provider Name | Dr. Elliot Haybarger |
First Address | Greenville, SC 29607-3984 |
Second Address | Greenville, SC 29615-1442 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2012 |
Last Update Date | 20/10/2016 |