Provider Demographics
NPI:1972527786
Name:HAIDER, SYED MOHSIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SYED
Middle Name:MOHSIN
Last Name:HAIDER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:SYED
Other - Middle Name:
Other - Last Name:HAIDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:4100 FAIRWAY DR
Mailing Address - Street 2:SUITE # 520
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-6525
Mailing Address - Country:US
Mailing Address - Phone:972-939-5439
Mailing Address - Fax:973-939-7022
Practice Address - Street 1:4100 FAIRWAY DR
Practice Address - Street 2:SUITE 520
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-6525
Practice Address - Country:US
Practice Address - Phone:972-939-5439
Practice Address - Fax:973-939-7022
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX200791223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX090830303Medicaid
TX203508815OtherTAX ID NUMBER