Provider Demographics
NPI:1003254335
Name:RAJI HADDAD D.D.S. INC. DBA FIRST FAMILY DENTAL
Entity Type:Organization
Organization Name:RAJI HADDAD D.D.S. INC. DBA FIRST FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESEDANT
Authorized Official - Prefix:
Authorized Official - First Name:RAJI
Authorized Official - Middle Name:
Authorized Official - Last Name:HADDAD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-229-8200
Mailing Address - Street 1:310 W SHAW AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-2646
Mailing Address - Country:US
Mailing Address - Phone:559-229-8200
Mailing Address - Fax:
Practice Address - Street 1:310 W SHAW AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-2646
Practice Address - Country:US
Practice Address - Phone:559-229-8200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-09
Last Update Date:2013-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39001122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA39001OtherGENERAL DENTISTRY