Provider Demographics
NPI:1033760632
Name:FAINO, NICHOLAS ANGELO (DMD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:ANGELO
Last Name:FAINO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 SUMMIT AVE APT A106
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-2340
Mailing Address - Country:US
Mailing Address - Phone:267-250-2703
Mailing Address - Fax:
Practice Address - Street 1:601D BETHLEHEM PIKE STE 200
Practice Address - Street 2:
Practice Address - City:MONTGOMERYVILLE
Practice Address - State:PA
Practice Address - Zip Code:18936-9713
Practice Address - Country:US
Practice Address - Phone:215-646-3040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS042446122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist