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General NPI Number Information
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NPI Number | 1811440076
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Entity Type | Individual
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Provider Name | MHD NADIM HAIDAR DDS
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Gender | Male
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Dates
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Enumeration Date | 07/25/2016
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Last Update Date | 10/01/2017
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Provider Practice Location Address
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Address Line | 194 N HIGHWAY 27 STE F
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City | CLERMONT
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State | FL
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Zip | 34711-2448
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Country | US
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Telephone | 352-243-0018
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Fax |
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Provider Business Mailing Address
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Address Line | 5908 STRADA CAPRI WAY
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City | ORLANDO
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State | FL
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Zip | 32835-3285
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Country | US
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Telephone | 561-809-3391
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN22196
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License Number State | FL
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