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General NPI Number Information
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NPI Number | 1790760700
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Entity Type | Individual
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Provider Name | JAY IBRAHIM HADDAD D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 12/13/2005
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Last Update Date | 02/21/2023
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Provider Practice Location Address
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Address Line | 6550 MERCANTILE DR E STE 101
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City | FREDERICK
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State | MD
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Zip | 21703-7656
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Country | US
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Telephone | 301-694-0870
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Fax | 301-694-7034
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Provider Business Mailing Address
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Address Line | 7625 MAPLE LAWN BLVD SUITE 240
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City | FULTON
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State | MD
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Zip | 20759-2565
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Country | US
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Telephone | 301-617-3404
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Fax | 301-617-3407
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 13498
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License Number State | MD
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