MEDICARE: EIAD HADDAD DDS INC

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	44888	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B 44888-01	OTHER	CA	MEDICAL

General Provider Information

NPI Number	:	1851565659
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EIAD HADDAD DDS INC

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	:

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	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. EIAD HALIM HADDAD
Credential	:	DDS
Telephone Number	:	619-660-6633

Provider Enumeration Date	:	04/14/2008
Last Update Date	:	04/14/2008

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