MEDICARE: DR. TAREQ KAMAL HADDAD DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	14365	MD
2	1223P0700X	Prosthodontics	14365	MD

General Provider Information

NPI Number	:	1366688392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAREQ KAMAL HADDAD DDS

Provider Business Mailing Address
First Line	:	110 WEST RD STE 200
Second Line	:
City	:	TOWSON
State	:	MD
Zip	:	21204-2341
Country	:	US
Telephone Number	:	410-296-0136
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 WEST RD STE 200
Second Line	:
City	:	TOWSON
State	:	MD
Zip	:	21204-2341
Country	:	US
Telephone Number	:	410-296-0136
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2008
Last Update Date	:	01/30/2025

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