Provider Demographics
NPI:1134484900
Name:HAIDER, MOHAMMAD SHIRAZ (DDS)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:SHIRAZ
Last Name:HAIDER
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 1:3116 E WOODBINE RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-2090
Mailing Address - Country:US
Mailing Address - Phone:949-302-9124
Mailing Address - Fax:
Practice Address - Street 1:20672 LAKE FOREST DR
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-7744
Practice Address - Country:US
Practice Address - Phone:949-302-9124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64017122300000X
OH30.023830122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist