Provider Demographics
NPI:1437167467
Name:HADDAD, R EDMOND (MS DDS)
Entity type:Individual
Prefix:DR
First Name:R
Middle Name:EDMOND
Last Name:HADDAD
Suffix:
Gender:M
Credentials:MS DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 GRASS VALLEY HWY
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603
Mailing Address - Country:US
Mailing Address - Phone:530-888-1567
Mailing Address - Fax:530-888-9183
Practice Address - Street 1:291 GRASS VALLEY HWY
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603
Practice Address - Country:US
Practice Address - Phone:530-888-1567
Practice Address - Fax:530-888-9183
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37835122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist