Provider Demographics
NPI:1255497673
Name:FAHEY, THOMAS B JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:B
Last Name:FAHEY
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 SHETLAND HILLS DR
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-5843
Mailing Address - Country:US
Mailing Address - Phone:410-828-0067
Mailing Address - Fax:
Practice Address - Street 1:6601 YORK RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-2026
Practice Address - Country:US
Practice Address - Phone:410-377-2000
Practice Address - Fax:410-377-2145
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD48091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice