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General NPI Number Information
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NPI Number | 1023793288
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Entity Type | Individual
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Provider Name | HAIDER ALDALLY DMD
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Gender | Male
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Dates
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Enumeration Date | 06/15/2023
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Last Update Date | 07/29/2024
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Provider Practice Location Address
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Address Line | 540 STATE ROAD 13 N STE 101
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City | FRUIT COVE
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State | FL
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Zip | 32259-3873
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Country | US
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Telephone | 904-217-4019
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Fax |
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Provider Business Mailing Address
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Address Line | 54 BOULDER LN
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City | ST JOHNS
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State | FL
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Zip | 32259-3296
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Country | US
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Telephone | 832-829-3633
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN28119
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License Number State | FL
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