Provider Demographics
NPI:1770715229
Name:HADA, RICHARD KAY (DMD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:KAY
Last Name:HADA
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 1:521 E ELDER ST STE 203
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-3083
Mailing Address - Country:US
Mailing Address - Phone:760-728-1592
Mailing Address - Fax:
Practice Address - Street 1:521 E ELDER ST STE 203
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-3083
Practice Address - Country:US
Practice Address - Phone:760-728-1592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA585001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice