Provider Demographics
NPI:1912620758
Name:HADDAD DENTISTRY, PLLC
Entity Type:Organization
Organization Name:HADDAD DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HADDAD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-930-1055
Mailing Address - Street 1:39150 DEQUINDRE RD STE 400
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-6975
Mailing Address - Country:US
Mailing Address - Phone:248-680-2125
Mailing Address - Fax:
Practice Address - Street 1:39150 DEQUINDRE RD STE 400
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-6975
Practice Address - Country:US
Practice Address - Phone:248-680-2125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental