Provider Demographics
NPI:1780979393
Name:AL-HADDADIN, HANAN SALIM
Entity type:Individual
Prefix:
First Name:HANAN
Middle Name:SALIM
Last Name:AL-HADDADIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11511 MAGNOLIA AVE UNIT 101
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-4837
Mailing Address - Country:US
Mailing Address - Phone:951-966-8964
Mailing Address - Fax:
Practice Address - Street 1:11511 MAGNOLIA AVE UNIT 101
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-4837
Practice Address - Country:US
Practice Address - Phone:951-966-8964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60391122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist