Provider Demographics
NPI:1356443246
Name:HAIDAR, EYAD (DMD)
Entity Type:Individual
Prefix:DR
First Name:EYAD
Middle Name:
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 1:494 NORTH AVE
Mailing Address - Street 2:ROUTE 117
Mailing Address - City:WESTON
Mailing Address - State:MA
Mailing Address - Zip Code:02493-1806
Mailing Address - Country:US
Mailing Address - Phone:781-893-1079
Mailing Address - Fax:781-893-1240
Practice Address - Street 1:494 NORTH AVE
Practice Address - Street 2:ROUTE 117
Practice Address - City:WESTON
Practice Address - State:MA
Practice Address - Zip Code:02493-1806
Practice Address - Country:US
Practice Address - Phone:781-893-1079
Practice Address - Fax:781-893-1240
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA191141223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics