Healthcare Provider Details

I. General information

NPI: 1881760973
Provider Name (Legal Business Name): ABRAHAM W HADDAD DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 COMMERCIAL STREET SUITE 430
WORCESTER MA
01608-1796
US

IV. Provider business mailing address

250 COMMERCIAL ST SUITE 430
WORCESTER MA
01608-1796
US

V. Phone/Fax

Practice location:
  • Phone: 508-754-5444
  • Fax: 508-752-3080
Mailing address:
  • Phone: 508-754-5444
  • Fax: 508-752-3080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number21379
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number10719
License Number StateMA

VIII. Authorized Official

Name: ABRAHAM W HADDAD
Title or Position: PRESIDENT
Credential: DMD
Phone: 508-753-5444