Provider Demographics
NPI:1700905403
Name:HAERIAN, ANDRE H (DDS, MS, FRCD, PHD)
Entity Type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:H
Last Name:HAERIAN
Suffix:
Gender:M
Credentials:DDS, MS, FRCD, PHD
Other - Prefix:
Other - First Name:HAMED
Other - Middle Name:A
Other - Last Name:HAERIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6407 MONROE STREET
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560
Mailing Address - Country:US
Mailing Address - Phone:419-882-1017
Mailing Address - Fax:419-882-7571
Practice Address - Street 1:6407 MONROE STREET
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560
Practice Address - Country:US
Practice Address - Phone:419-882-1017
Practice Address - Fax:419-882-7571
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300202171223X0400X
MI167051223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics