Provider Demographics
NPI:1083624894
Name:HAIK, TOMER (DDS)
Entity Type:Individual
Prefix:DR
First Name:TOMER
Middle Name:
Last Name:HAIK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3319 STATE ROAD 7
Mailing Address - Street 2:SUITE 213
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33449-8094
Mailing Address - Country:US
Mailing Address - Phone:561-333-8441
Mailing Address - Fax:561-333-8507
Practice Address - Street 1:3319 STATE ROAD 7
Practice Address - Street 2:SUITE 312
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33449-8094
Practice Address - Country:US
Practice Address - Phone:561-333-8441
Practice Address - Fax:561-333-8507
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN163551223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL076136200Medicaid