Basic Information
Provider Information
NPI: 1073850897
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SADOON
FirstName: IHAB
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: D.D.S
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4100 QUARLES COURT
Address2:  
City: HARRISONBURG
State: VA
PostalCode: 22801
CountryCode: US
TelephoneNumber: 5404320609
FaxNumber: 5404329097
Practice Location
Address1: 4100 QUARLES COURT
Address2:  
City: HARRISONBURG
State: VA
PostalCode: 22801
CountryCode: US
TelephoneNumber: 5404320609
FaxNumber: 5404329097
Other Information
ProviderEnumerationDate: 01/14/2013
LastUpdateDate: 01/14/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
122300000X0401413861NYY Dental ProvidersDentist 

No ID Information.


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