Provider Demographics
NPI:1962542431
Name:HADDAD, RAYMOND DAVID (DMD)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:DAVID
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 1:2313 HWY 27/441
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:34731-2126
Mailing Address - Country:US
Mailing Address - Phone:386-316-5771
Mailing Address - Fax:
Practice Address - Street 1:2313 HWY 27/441
Practice Address - Street 2:
Practice Address - City:FRUITLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:34731-2126
Practice Address - Country:US
Practice Address - Phone:386-316-5771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN-51681223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery