Provider Demographics
NPI:1811669203
Name:AL HAYDAR, BANA (DDS,MS)
Entity type:Individual
Prefix:DR
First Name:BANA
Middle Name:
Last Name:AL HAYDAR
Suffix:
Gender:F
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 1:5500 39TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20015-2904
Mailing Address - Country:US
Mailing Address - Phone:202-823-8580
Mailing Address - Fax:
Practice Address - Street 1:609 JEFFERSON DAVIS HWY STE 101
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4566
Practice Address - Country:US
Practice Address - Phone:540-373-3066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014176571223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics