Provider Demographics
NPI:1790760700
Name:HADDAD, JAY IBRAHIM (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:IBRAHIM
Last Name:HADDAD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JIHAD
Other - Middle Name:IBRAHIM
Other - Last Name:HADDAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:7625 MAPLE LAWN BLVD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759-2565
Mailing Address - Country:US
Mailing Address - Phone:301-617-3404
Mailing Address - Fax:301-617-3407
Practice Address - Street 1:6550 MERCANTILE DR E STE 101
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-7656
Practice Address - Country:US
Practice Address - Phone:301-694-0870
Practice Address - Fax:301-694-7034
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD134981223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery