Provider Demographics
NPI:1376703686
Name:TADROS, FAWZY (DDS)
Entity Type:Individual
Prefix:
First Name:FAWZY
Middle Name:
Last Name:TADROS
Suffix:
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 1:12601 SAN FERNANDO RD STE H
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-7733
Mailing Address - Country:US
Mailing Address - Phone:818-364-1991
Mailing Address - Fax:818-364-1993
Practice Address - Street 1:12601 SAN FERNANDO RD STE H
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-7733
Practice Address - Country:US
Practice Address - Phone:818-364-1991
Practice Address - Fax:818-364-1993
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA496771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice