Healthcare Provider Details

I. General information

NPI: 1649622762
Provider Name (Legal Business Name): HADI A LUTFI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2016
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PROSPECT AVE STE 719
HACKENSACK NJ
07601-1974
US

IV. Provider business mailing address

20 PROSPECT AVE STE 719
HACKENSACK NJ
07601-1974
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-5002
  • Fax: 551-996-5099
Mailing address:
  • Phone: 551-996-5002
  • Fax: 551-996-5099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number4698
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2901022013
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number22DI02957500
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: