Provider Demographics
NPI:1114041456
Name:HAIDAR, LOUIE
Entity Type:Individual
Prefix:DR
First Name:LOUIE
Middle Name:
Last Name:HAIDAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8076 DICENZA LN
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92119-1124
Mailing Address - Country:US
Mailing Address - Phone:858-335-9390
Mailing Address - Fax:
Practice Address - Street 1:12649 POWAY RD
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-4415
Practice Address - Country:US
Practice Address - Phone:858-486-6100
Practice Address - Fax:858-486-4564
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA517801223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD51780Medicaid