Provider Demographics
NPI:1467577601
Name:FADDIR, SHAWN S (RDH)
Entity Type:Individual
Prefix:MS
First Name:SHAWN
Middle Name:S
Last Name:FADDIR
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 VERDE VALLEY LN
Mailing Address - Street 2:#165
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254
Mailing Address - Country:US
Mailing Address - Phone:214-499-8843
Mailing Address - Fax:972-618-9369
Practice Address - Street 1:6841 COIT RD
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-5417
Practice Address - Country:US
Practice Address - Phone:972-618-5000
Practice Address - Fax:972-618-9369
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10815124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist