Healthcare Provider Details

I. General information

NPI: 1790109098
Provider Name (Legal Business Name): HAIDER MICHAEL KALHAN B.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: HAIDER AL MOHAMADWAY

II. Dates (important events)

Enumeration Date: 02/07/2014
Last Update Date: 11/11/2023
Certification Date: 11/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 W 1ST AVE
TOPPENISH WA
98948-1564
US

IV. Provider business mailing address

3800 BYRON AVE STE 100
BELLINGHAM WA
98229-2877
US

V. Phone/Fax

Practice location:
  • Phone: 509-865-3886
  • Fax: 509-865-6391
Mailing address:
  • Phone: 360-282-0804
  • Fax: 360-550-6505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberRR60356146
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE60465251
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: