Provider Demographics
NPI:1114233319
Name:BADLISSI, FAYEZ GEORGE (DMD)
Entity Type:Individual
Prefix:DR
First Name:FAYEZ
Middle Name:GEORGE
Last Name:BADLISSI
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 1:550 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-1735
Mailing Address - Country:US
Mailing Address - Phone:508-222-2510
Mailing Address - Fax:
Practice Address - Street 1:550 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-1735
Practice Address - Country:US
Practice Address - Phone:508-222-2510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA186041223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics