Healthcare Provider Details

I. General information

NPI: 1508066077
Provider Name (Legal Business Name): FAHAD M ALSAAD DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: FAHAD ALSAAD DDS

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 06/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HITTEEN AREA HOUES #17 ST 403.
KUWAIT KUWAIT
000
KW

IV. Provider business mailing address

3503 JACK NORTHROP AVE SUITE #FU362
HAWTHORNE CA
90250-4433
US

V. Phone/Fax

Practice location:
  • Phone: 804-402-3344
  • Fax:
Mailing address:
  • Phone: 804-402-3344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401411894
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number0442000113
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: