MEDICARE: HATEM ABDELHADI 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	57440	CA

General Provider Information

NPI Number	:	1891169058
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HATEM ABDELHADI DDS INC

Provider Business Mailing Address
First Line	:	12342 GLACIER CIR
Second Line	:
City	:	LOS ALAMITOS
State	:	CA
Zip	:	90720-5136
Country	:	US
Telephone Number	:	562-810-3066
Fax Number	:

Provider Business Practice Location Address
First Line	:	3532 HOWARD AVE
Second Line	:	101
City	:	LOS ALAMITOS
State	:	CA
Zip	:	90720-3681
Country	:	US
Telephone Number	:	562-810-3066
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. HATEM ABDELHADI
Credential	:	DDS
Telephone Number	:	562-810-3066

Provider Enumeration Date	:	11/25/2015
Last Update Date	:	04/04/2016

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