Provider Demographics
NPI:1124631270
Name:HEDO, HADEEL (DDS)
Entity type:Individual
Prefix:DR
First Name:HADEEL
Middle Name:
Last Name:HEDO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 ORO ST APT 13
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-4953
Mailing Address - Country:US
Mailing Address - Phone:619-456-8272
Mailing Address - Fax:
Practice Address - Street 1:8657 VILLA LA JOLLA DR STE 211
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-8309
Practice Address - Country:US
Practice Address - Phone:858-272-2260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105384122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist