Provider Demographics
NPI:1235424292
Name:HADDAD, ROBERT ANTOINE JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ANTOINE
Last Name:HADDAD
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4241 KIMBERLY PKWY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-7225
Mailing Address - Country:US
Mailing Address - Phone:440-668-5876
Mailing Address - Fax:
Practice Address - Street 1:4241 KIMBERLY PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-7225
Practice Address - Country:US
Practice Address - Phone:614-866-7445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30023442122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist