Provider Demographics
NPI:1326577420
Name:HABEEB, EBAD (DMD)
Entity type:Individual
Prefix:DR
First Name:EBAD
Middle Name:
Last Name:HABEEB
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 1:3611 BRASELTON HWY STE 104
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-4672
Mailing Address - Country:US
Mailing Address - Phone:770-945-2733
Mailing Address - Fax:770-945-7633
Practice Address - Street 1:3611 BRASELTON HWY STE 104
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-4672
Practice Address - Country:US
Practice Address - Phone:770-945-2733
Practice Address - Fax:770-945-7633
Is Sole Proprietor?:No
Enumeration Date:2017-06-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0154371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice