Provider Demographics
NPI:1083054647
Name:HAIDAR, FATIHMA (DDS)
Entity Type:Individual
Prefix:DR
First Name:FATIHMA
Middle Name:
Last Name:HAIDAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4302 CHESTNUT HLS
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-0801
Mailing Address - Country:US
Mailing Address - Phone:304-685-6778
Mailing Address - Fax:
Practice Address - Street 1:4302 CHESTNUT HLS
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-0801
Practice Address - Country:US
Practice Address - Phone:304-685-6778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-27
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS039636122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist