Provider Demographics
NPI:1710198734
Name:KADISH, HAROLD A (DMD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:A
Last Name:KADISH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 HYDE AVE
Mailing Address - Street 2:P.O. BOX 538
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-4503
Mailing Address - Country:US
Mailing Address - Phone:860-875-0791
Mailing Address - Fax:860-872-1546
Practice Address - Street 1:44 HYDE AVE
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-4503
Practice Address - Country:US
Practice Address - Phone:860-875-0791
Practice Address - Fax:860-872-1546
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT39061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice