Provider Demographics
NPI:1073815577
Name:KADDI, AHMED (BDS)
Entity Type:Individual
Prefix:DR
First Name:AHMED
Middle Name:
Last Name:KADDI
Suffix:
Gender:M
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 WASHINGTON ST
Mailing Address - Street 2:APT 7
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-8200
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:68 WASHINGTON ST
Practice Address - Street 2:APT 7
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-8200
Practice Address - Country:US
Practice Address - Phone:617-638-4670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-03
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL11162122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist