Provider Demographics
NPI:1740610245
Name:HATAHET, AHMAD REDA (DMD)
Entity Type:Individual
Prefix:DR
First Name:AHMAD
Middle Name:REDA
Last Name:HATAHET
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 1:40600 BLYTHEFIELD LN
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-2251
Mailing Address - Country:US
Mailing Address - Phone:734-218-3044
Mailing Address - Fax:
Practice Address - Street 1:2360 E STADIUM BLVD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-4887
Practice Address - Country:US
Practice Address - Phone:734-677-0793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-19
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901021192122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist