Provider Demographics
NPI:1407084288
Name:HADDAD, GEORGIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGIA
Middle Name:
Last Name:HADDAD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:GEORGIA
Other - Middle Name:
Other - Last Name:RADFAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1801 SOLAR DR STE 290
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-0155
Mailing Address - Country:US
Mailing Address - Phone:310-720-2313
Mailing Address - Fax:805-497-9914
Practice Address - Street 1:1801 SOLAR DR STE 290
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-0155
Practice Address - Country:US
Practice Address - Phone:310-720-2313
Practice Address - Fax:805-497-9914
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49896122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist