Provider Demographics
NPI:1023039864
Name:HADDAD, FRED C (DMD)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:C
Last Name:HADDAD
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 1:477 GREENTREE RD STE C
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-9339
Mailing Address - Country:US
Mailing Address - Phone:856-589-7789
Mailing Address - Fax:
Practice Address - Street 1:477 GREENTREE RD STE C
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-9339
Practice Address - Country:US
Practice Address - Phone:856-589-7789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI0206261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice