Provider Demographics
NPI:1790803906
Name:RADAIDEH, HANI MORSHED (DDS)
Entity Type:Individual
Prefix:DR
First Name:HANI
Middle Name:MORSHED
Last Name:RADAIDEH
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 1:1248 W SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:WILLOWS
Mailing Address - State:CA
Mailing Address - Zip Code:95988-2603
Mailing Address - Country:US
Mailing Address - Phone:530-934-5071
Mailing Address - Fax:530-934-9480
Practice Address - Street 1:1248 W SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:WILLOWS
Practice Address - State:CA
Practice Address - Zip Code:95988-2603
Practice Address - Country:US
Practice Address - Phone:530-934-5071
Practice Address - Fax:530-934-9480
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA451771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice