Provider Demographics
NPI:1457863649
Name:JEREMY HAIDER DMD PC
Entity Type:Organization
Organization Name:JEREMY HAIDER DMD PC
Other - Org Name:HAIDER FAMILY DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:R.
Authorized Official - Middle Name:JEREMY
Authorized Official - Last Name:HAIDER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-363-6525
Mailing Address - Street 1:2600 12TH ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-2155
Mailing Address - Country:US
Mailing Address - Phone:503-363-6525
Mailing Address - Fax:
Practice Address - Street 1:2600 12TH ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-2155
Practice Address - Country:US
Practice Address - Phone:503-363-6525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-29
Last Update Date:2017-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD8985261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental