Healthcare Provider Details

I. General information

NPI: 1225764616
Provider Name (Legal Business Name): HAIAR DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2022
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 S CLIFF AVE STE 102
SIOUX FALLS SD
57108-5400
US

IV. Provider business mailing address

5200 S CLIFF AVE STE 102
SIOUX FALLS SD
57108-5400
US

V. Phone/Fax

Practice location:
  • Phone: 605-799-2929
  • Fax: 605-252-9500
Mailing address:
  • Phone: 605-799-2929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: KEVIN MICHAEL HAIAR
Title or Position: OWNER, DENTIST
Credential: DDS, DABOI
Phone: 605-799-2929