Taj M. Haynes DMD, PA

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

8832 Issued in NC

Legal business name

TAJ M. HAYNES DMD, PA

Doing business as

Modern Family Dental Care

Practice address

8455 Pit Stop CT NW
Suite 140
Concord, NC 28027-8249

Phone

(704) 979-3436

NPI assigned

Apr 14, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Taj Michael Haynes, DMD

Title

President

Phone

(704) 979-3436

Specialties & licenses 1

Addresses

Other names 1

• Modern Family Dental Care Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1302739200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1302739200000",
    "number": "1912297623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8455 PIT STOP CT NW",
            "address_2": "SUITE 140",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280278249",
            "telephone_number": "704-979-3436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8455 PIT STOP CT NW",
            "address_2": "SUITE 140",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280278249",
            "telephone_number": "704-979-3436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TAJ M. HAYNES DMD, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-14",
        "last_updated": "2011-04-14",
        "status": "A",
        "authorized_official_last_name": "HAYNES",
        "authorized_official_first_name": "TAJ",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "704-979-3436",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "8832",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Modern Family Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Dentistry in Concord, NC
• Providers in Concord, NC by specialty
• General Practice Dentistry in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.