Provider Demographics
NPI:1154511145
Name:HAJDARI, HALED (DDS)
Entity Type:Individual
Prefix:
First Name:HALED
Middle Name:
Last Name:HAJDARI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:ED
Other - Middle Name:
Other - Last Name:HAJDARI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1200 N TUSTIN AVE
Mailing Address - Street 2:110
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3508
Mailing Address - Country:US
Mailing Address - Phone:714-973-1492
Mailing Address - Fax:714-973-8187
Practice Address - Street 1:1200 N TUSTIN AVE
Practice Address - Street 2:110
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3508
Practice Address - Country:US
Practice Address - Phone:714-973-1492
Practice Address - Fax:714-973-8187
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA509201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice