Provider Demographics
NPI:1457499899
Name:FAYAD, MOHAMED (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:
Last Name:FAYAD
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2729A N GREENVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1117
Mailing Address - Country:US
Mailing Address - Phone:312-236-9581
Mailing Address - Fax:312-236-9593
Practice Address - Street 1:55 E WASHINGTON ST
Practice Address - Street 2:SUITE #1230
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-2103
Practice Address - Country:US
Practice Address - Phone:312-236-9581
Practice Address - Fax:312-236-9593
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19-0250141223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics