Provider Demographics
NPI:1366688392
Name:HADDAD, TAREQ KAMAL (DDS)
Entity type:Individual
Prefix:DR
First Name:TAREQ
Middle Name:KAMAL
Last Name:HADDAD
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 1:110 WEST RD STE 200
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2341
Mailing Address - Country:US
Mailing Address - Phone:410-296-0136
Mailing Address - Fax:
Practice Address - Street 1:110 WEST RD STE 200
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2341
Practice Address - Country:US
Practice Address - Phone:410-296-0136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-22
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14365122300000X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist