Active NPI
Colby Haines, D.D.S.
- Dentist
- Bethel, AK
National Provider Identifier
1417409210
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 114079
- Practice address
- 829 Chief Eddie Hoffman Highway
Bethel, AK 99559 - Phone
- (907) 229-7062
- NPI assigned
- Oct 27, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 114079 | AK | Primary |
Addresses
Primary practice location
829 Chief Eddie Hoffman Highway
Bethel, AK 99559
Mailing address
PO Box 1524
Bethel, AK 99559-1524
Phone (907) 229-7062
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20181231000104 | NY | Order and Referring Only - Dentist | 3678818218 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 114079 | AK | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1477526400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1477526400000",
"number": "1417409210",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1524",
"city": "BETHEL",
"state": "AK",
"postal_code": "995591524",
"telephone_number": "907-229-7062"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "829 CHIEF EDDIE HOFFMAN HIGHWAY",
"city": "BETHEL",
"state": "AK",
"postal_code": "99559",
"telephone_number": "907-229-7062"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAINES",
"first_name": "COLBY",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-10-27",
"last_updated": "2016-10-27",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AK",
"license": "114079",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bethel, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.