Provider Demographics
NPI:1023856382
Name:HAIDER, BARAK BARAKZI (DDS)
Entity type:Individual
Prefix:DR
First Name:BARAK
Middle Name:BARAKZI
Last Name:HAIDER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14608 JENN CT
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-5427
Mailing Address - Country:US
Mailing Address - Phone:703-508-6240
Mailing Address - Fax:
Practice Address - Street 1:2900 ML KING JR BLVD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-4247
Practice Address - Country:US
Practice Address - Phone:252-288-3023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-19
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC139901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program