Provider Demographics
NPI:1285026492
Name:HAIDAR, HASSAN (DDS)
Entity Type:Individual
Prefix:
First Name:HASSAN
Middle Name:
Last Name:HAIDAR
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 1:1100 N STATE ST
Mailing Address - Street 2:CT-A7D
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-5000
Mailing Address - Country:US
Mailing Address - Phone:323-409-6931
Mailing Address - Fax:
Practice Address - Street 1:1100 N STATE ST
Practice Address - Street 2:CT-A7D
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5000
Practice Address - Country:US
Practice Address - Phone:323-409-6931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-25
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA637691223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery