Provider Demographics
NPI:1174653711
Name:AOUN, FADI R (DMD)
Entity Type:Individual
Prefix:
First Name:FADI
Middle Name:R
Last Name:AOUN
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 1:3639 KIESSEL RD
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32163-2909
Mailing Address - Country:US
Mailing Address - Phone:352-350-7445
Mailing Address - Fax:352-350-7445
Practice Address - Street 1:3639 KIESSEL RD
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32163-2909
Practice Address - Country:US
Practice Address - Phone:352-350-7445
Practice Address - Fax:407-696-2839
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL159201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice