MEDICARE: DR. HAISSAM RAMADAN D.M.D.

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	122300000X	Dentist	105555	CT

General Provider Information

NPI Number	:	1467723734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HAISSAM RAMADAN D.M.D.

Provider Business Mailing Address
First Line	:	175 CANTON ST
Second Line	:	APT B15
City	:	WEST HAVEN
State	:	CT
Zip	:	06516-2233
Country	:	US
Telephone Number	:	203-795-0000
Fax Number	:

Provider Business Practice Location Address
First Line	:	57 NORTH ST STE 318
Second Line	:
City	:	DANBURY
State	:	CT
Zip	:	06810-5628
Country	:	US
Telephone Number	:	203-826-9299
Fax Number	:

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

Provider Enumeration Date	:	01/19/2012
Last Update Date	:	04/29/2019

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