Provider Demographics
NPI:1689903460
Name:HABEEB, TODD D (DMD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:D
Last Name:HABEEB
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:TODD
Other - Middle Name:DANIEL
Other - Last Name:HABEEB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:115 MOOSIC ROAD
Mailing Address - Street 2:
Mailing Address - City:OLD FORGE
Mailing Address - State:PA
Mailing Address - Zip Code:18518-1851
Mailing Address - Country:US
Mailing Address - Phone:570-457-3444
Mailing Address - Fax:
Practice Address - Street 1:115 MOOSIC RD
Practice Address - Street 2:
Practice Address - City:OLD FORGE
Practice Address - State:PA
Practice Address - Zip Code:18518-2018
Practice Address - Country:US
Practice Address - Phone:570-457-3444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-026746-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice