Provider Demographics
NPI:1659415511
Name:HADAD, SELIMA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SELIMA
Middle Name:
Last Name:HADAD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9929 HAWTHORNE GLEN DR
Mailing Address - Street 2:
Mailing Address - City:GROSSE ILE
Mailing Address - State:MI
Mailing Address - Zip Code:48138-2117
Mailing Address - Country:US
Mailing Address - Phone:734-674-3484
Mailing Address - Fax:734-675-4266
Practice Address - Street 1:19636 ALLEN RD
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN TWP
Practice Address - State:MI
Practice Address - Zip Code:48183-1022
Practice Address - Country:US
Practice Address - Phone:734-479-4600
Practice Address - Fax:734-479-4603
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI169221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice