Provider Demographics
NPI: | 1699985333 |
---|---|
Name: | HAID DENTAL ASSOCIATES |
Entity type: | Organization |
Organization Name: | HAID DENTAL ASSOCIATES |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | EXECUTIVE |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | TARA |
Authorized Official - Middle Name: | L |
Authorized Official - Last Name: | HAID |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DDS |
Authorized Official - Phone: | 614-885-2610 |
Mailing Address - Street 1: | 250 W BRIDGE ST |
Mailing Address - Street 2: | STE.201 |
Mailing Address - City: | DUBLIN |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 43017-2123 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 614-889-7661 |
Mailing Address - Fax: | 614-889-6179 |
Practice Address - Street 1: | 250 W BRIDGE ST |
Practice Address - Street 2: | STE.201 |
Practice Address - City: | DUBLIN |
Practice Address - State: | OH |
Practice Address - Zip Code: | 43017-2123 |
Practice Address - Country: | US |
Practice Address - Phone: | 614-889-7661 |
Practice Address - Fax: | 614-889-6179 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-05-23 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OH | 21394 | 1223G0001X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1223G0001X | Dental Providers | Dentist | General Practice | Group - Single Specialty |