Provider Demographics
NPI:1790109098
Name:KALHAN, HAIDER MICHAEL (BDS)
Entity Type:Individual
Prefix:
First Name:HAIDER
Middle Name:MICHAEL
Last Name:KALHAN
Suffix:
Gender:M
Credentials:BDS
Other - Prefix:
Other - First Name:HAIDER
Other - Middle Name:
Other - Last Name:AL MOHAMADWAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3800 BYRON AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-2877
Mailing Address - Country:US
Mailing Address - Phone:360-282-0804
Mailing Address - Fax:360-550-6505
Practice Address - Street 1:518 W 1ST AVE
Practice Address - Street 2:
Practice Address - City:TOPPENISH
Practice Address - State:WA
Practice Address - Zip Code:98948-1564
Practice Address - Country:US
Practice Address - Phone:509-865-3886
Practice Address - Fax:509-865-6391
Is Sole Proprietor?:No
Enumeration Date:2014-02-07
Last Update Date:2023-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARR603561461223D0001X
WADE60465251122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1790109098Medicaid