Provider Demographics
NPI:1114411162
Name:HAIDAR, HADI KARAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:HADI
Middle Name:KARAM
Last Name:HAIDAR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 DESOTO RD
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-6033
Mailing Address - Country:US
Mailing Address - Phone:617-412-7776
Mailing Address - Fax:
Practice Address - Street 1:726 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-3036
Practice Address - Country:US
Practice Address - Phone:781-821-2120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-21
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18580551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice