Provider Demographics
NPI:1356801989
Name:HADDAD, LOUAI (DDS)
Entity type:Individual
Prefix:
First Name:LOUAI
Middle Name:
Last Name:HADDAD
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:FAISAL FARHAN AL JARBA STREET
Mailing Address - Street 2:TLAA AL ALI BUILDING NUMBER 52
Mailing Address - City:AMMAN
Mailing Address - State:AMMAN
Mailing Address - Zip Code:11953
Mailing Address - Country:JO
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3009 E 92ND ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-4502
Practice Address - Country:US
Practice Address - Phone:860-960-9560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190343121223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics