Provider Demographics
NPI:1295845261
Name:EBID, FADY G (DMD)
Entity Type:Individual
Prefix:
First Name:FADY
Middle Name:G
Last Name:EBID
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 1:6615 HICKORY FLAT HWY
Mailing Address - Street 2:STE 100
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-7237
Mailing Address - Country:US
Mailing Address - Phone:770-872-0548
Mailing Address - Fax:770-872-0548
Practice Address - Street 1:3950 COBB PKWY NW
Practice Address - Street 2:SUITE 402
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-9532
Practice Address - Country:US
Practice Address - Phone:770-966-9396
Practice Address - Fax:770-966-8774
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0123951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA180312557AMedicaid