Provider Demographics
NPI:1598098592
Name:AL-HABAJ, FIRAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:FIRAS
Middle Name:
Last Name:AL-HABAJ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:FIRAS
Other - Middle Name:
Other - Last Name:HABAJ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:2138 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-5131
Mailing Address - Country:US
Mailing Address - Phone:419-241-1644
Mailing Address - Fax:419-249-6581
Practice Address - Street 1:2138 MADISON AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-5131
Practice Address - Country:US
Practice Address - Phone:419-241-1644
Practice Address - Fax:419-249-6581
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH213011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2541299Medicaid