Provider Demographics
NPI:1528635638
Name:ABDELHADI, AHMED (DDS)
Entity type:Individual
Prefix:
First Name:AHMED
Middle Name:
Last Name:ABDELHADI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4403 STAGECOACH RD
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-1780
Mailing Address - Country:US
Mailing Address - Phone:617-230-5116
Mailing Address - Fax:
Practice Address - Street 1:128 HERLONG AVE S STE 102
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1156
Practice Address - Country:US
Practice Address - Phone:803-825-4815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDGD102951223G0001X
MADN18589981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice