Provider Demographics
NPI:1508066077
Name:ALSAAD, FAHAD M (DDS)
Entity Type:Individual
Prefix:DR
First Name:FAHAD
Middle Name:M
Last Name:ALSAAD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:FAHAD
Other - Middle Name:
Other - Last Name:ALSAAD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:3503 JACK NORTHROP AVE
Mailing Address - Street 2:SUITE #FU362
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-4433
Mailing Address - Country:US
Mailing Address - Phone:804-402-3344
Mailing Address - Fax:
Practice Address - Street 1:HITTEEN AREA HOUES #17 ST 403.
Practice Address - Street 2:
Practice Address - City:KUWAIT
Practice Address - State:KUWAIT
Practice Address - Zip Code:000
Practice Address - Country:KW
Practice Address - Phone:804-402-3344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401411894122300000X
VA0442000113122300000X
VA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program