Provider Demographics
NPI:1205099520
Name:HADDADEEN, YAZAN (DDS)
Entity type:Individual
Prefix:DR
First Name:YAZAN
Middle Name:
Last Name:HADDADEEN
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5716 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44127-1715
Mailing Address - Country:US
Mailing Address - Phone:216-415-5504
Mailing Address - Fax:
Practice Address - Street 1:5716 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44127-1715
Practice Address - Country:US
Practice Address - Phone:216-415-5504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60199807122300000X
OH30.023405122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist