MEDICARE: DR. EBAD HABEEB DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	015437	GA

General Provider Information

NPI Number	:	1326577420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EBAD HABEEB DMD

Provider Business Mailing Address
First Line	:	3611 BRASELTON HWY STE 104
Second Line	:
City	:	DACULA
State	:	GA
Zip	:	30019-4672
Country	:	US
Telephone Number	:	770-945-2733
Fax Number	:	770-945-7633

Provider Business Practice Location Address
First Line	:	3611 BRASELTON HWY STE 104
Second Line	:
City	:	DACULA
State	:	GA
Zip	:	30019-4672
Country	:	US
Telephone Number	:	770-945-2733
Fax Number	:	770-945-7633

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2017
Last Update Date	:	07/21/2022

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