MEDICARE: DR. EIAD H HADDAD DDS

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	44888	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B4488801	OTHER	CA	DENTICAL
2	979972	OTHER	CA	UNITED CONCODIA

General Provider Information

NPI Number	:	1437239365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EIAD H HADDAD DDS

Provider Business Mailing Address
First Line	:	10225 AUSTIN DR STE 205
Second Line	:
City	:	SPRING VALLEY
State	:	CA
Zip	:	91978-1522
Country	:	US
Telephone Number	:	619-660-6633
Fax Number	:	619-660-6721

Provider Business Practice Location Address
First Line	:	10225 AUSTIN DR STE 205
Second Line	:
City	:	SPRING VALLEY
State	:	CA
Zip	:	91978-1522
Country	:	US
Telephone Number	:	619-660-6633
Fax Number	:	619-660-6721

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

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	07/08/2007

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