Provider Demographics
NPI:1467723734
Name:RAMADAN, HAISSAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:HAISSAM
Middle Name:
Last Name:RAMADAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 CANTON ST
Mailing Address - Street 2:APT B15
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-2233
Mailing Address - Country:US
Mailing Address - Phone:203-795-0000
Mailing Address - Fax:
Practice Address - Street 1:57 NORTH ST STE 318
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-5628
Practice Address - Country:US
Practice Address - Phone:203-826-9299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-19
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT105555122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist