Provider Demographics
NPI:1710016027
Name:HADDAD, NADIM K (DDS)
Entity Type:Individual
Prefix:
First Name:NADIM
Middle Name:K
Last Name:HADDAD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 E BIG BEAVER RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1404
Mailing Address - Country:US
Mailing Address - Phone:248-680-2125
Mailing Address - Fax:248-680-2134
Practice Address - Street 1:840 E BIG BEAVER RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1404
Practice Address - Country:US
Practice Address - Phone:248-680-2125
Practice Address - Fax:248-680-2134
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI134631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice