MEDICARE: DR. EYAD HAIDAR DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0700X	Prosthodontics	19114	MA

General Provider Information

NPI Number	:	1356443246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EYAD HAIDAR DMD

Provider Business Mailing Address
First Line	:	494 NORTH AVE
Second Line	:	ROUTE 117
City	:	WESTON
State	:	MA
Zip	:	02493-1806
Country	:	US
Telephone Number	:	781-893-1079
Fax Number	:	781-893-1240

Provider Business Practice Location Address
First Line	:	494 NORTH AVE
Second Line	:	ROUTE 117
City	:	WESTON
State	:	MA
Zip	:	02493-1806
Country	:	US
Telephone Number	:	781-893-1079
Fax Number	:	781-893-1240

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	07/08/2007

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