Provider Demographics
NPI:1275209413
Name:OBEIDAT, RAGHAD
Entity Type:Individual
Prefix:
First Name:RAGHAD
Middle Name:
Last Name:OBEIDAT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3108 HOFFMAN DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-5735
Mailing Address - Country:US
Mailing Address - Phone:972-876-0200
Mailing Address - Fax:
Practice Address - Street 1:3108 HOFFMAN DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75025-5735
Practice Address - Country:US
Practice Address - Phone:972-876-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX370621223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty