Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DN16355 | FL |
NPI | 1083624894 |
---|---|
Provider Name | Dr. Tomer Haik |
First Address | Wellington, FL 33449-8094 |
Second Address | Wellington, FL 33449-8094 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 29/06/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
076136200 | (05) | FL |