Provider Demographics
NPI:1245432004
Name:HAIDER, ABBAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:ABBAS
Middle Name:
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 1:3521 MEMORIAL DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-2731
Mailing Address - Country:US
Mailing Address - Phone:404-557-2921
Mailing Address - Fax:404-567-8487
Practice Address - Street 1:3521 MEMORIAL DR
Practice Address - Street 2:SUITE A
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-2731
Practice Address - Country:US
Practice Address - Phone:404-557-2921
Practice Address - Fax:404-567-8487
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA118631223G0001X
TN75111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice