Provider Demographics
NPI:1225764616
Name:HAIAR DENTAL PLLC
Entity type:Organization
Organization Name:HAIAR DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HAIAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, DABOI
Authorized Official - Phone:605-799-2929
Mailing Address - Street 1:5200 S CLIFF AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-5400
Mailing Address - Country:US
Mailing Address - Phone:605-799-2929
Mailing Address - Fax:
Practice Address - Street 1:5200 S CLIFF AVE STE 102
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-5400
Practice Address - Country:US
Practice Address - Phone:605-799-2929
Practice Address - Fax:605-252-9500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1821405754OtherINDIVIDUAL NPI