Provider Demographics
NPI:1588737902
Name:HADDAD, ABRAHAM W (DMD)
Entity type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:W
Last Name:HADDAD
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 1:250 COMMERCIAL STREET
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:508-753-5444
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:508-753-5444
Practice Address - Fax:508-752-3080
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA107191223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics