Provider Demographics
NPI:1578654687
Name:HAIDET, JOHN J (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:HAIDET
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3750 ALWARD RD SW
Mailing Address - Street 2:
Mailing Address - City:PATASKALA
Mailing Address - State:OH
Mailing Address - Zip Code:43062-6701
Mailing Address - Country:US
Mailing Address - Phone:614-577-1100
Mailing Address - Fax:614-577-1348
Practice Address - Street 1:7334 E BROAD ST
Practice Address - Street 2:SUITE C
Practice Address - City:BLACKLICK
Practice Address - State:OH
Practice Address - Zip Code:43004-9239
Practice Address - Country:US
Practice Address - Phone:614-577-1100
Practice Address - Fax:614-577-1348
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH170621223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics