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General NPI Number Information
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NPI Number | 1821534967
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Entity Type | Organization
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Legal Business Name | HANI AHDAB DDS, LLC
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Dates
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Enumeration Date | 01/12/2017
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Last Update Date | 01/12/2017
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Provider Practice Location Address
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Address Line | 1209 WINTHROP AVE
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City | LAFAYETTE
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State | IN
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Zip | 47909-2420
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Country | US
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Telephone | 765-477-7722
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Fax |
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Provider Business Mailing Address
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Address Line | 328 STONEHEDGE DR
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City | CARMEL
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State | IN
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Zip | 46032-1274
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HANI AHDAB
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Credential | DDS, MS
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Telephone | 949-280-9609
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 12012631A
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License Number State | IN
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