Provider Demographics
NPI:1881760973
Name:ABRAHAM W HADDAD DMD PC
Entity type:Organization
Organization Name:ABRAHAM W HADDAD DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:W
Authorized Official - Last Name:HADDAD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-753-5444
Mailing Address - Street 1:250 COMMERCIAL ST
Mailing Address - Street 2:SUITE 430
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1796
Mailing Address - Country:US
Mailing Address - Phone:508-754-5444
Mailing Address - Fax:508-752-3080
Practice Address - Street 1:250 COMMERCIAL STREET
Practice Address - Street 2:SUITE 430
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1796
Practice Address - Country:US
Practice Address - Phone:508-754-5444
Practice Address - Fax:508-752-3080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA213791223P0300X
MA107191223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty