Provider Demographics
NPI:1508908492
Name:KEYORKGY, FADI GEORGE (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:FADI
Middle Name:GEORGE
Last Name:KEYORKGY
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48926 SCHOENHERR RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-4240
Mailing Address - Country:US
Mailing Address - Phone:586-566-5660
Mailing Address - Fax:
Practice Address - Street 1:16068 E 8 MILE RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48205-1416
Practice Address - Country:US
Practice Address - Phone:313-372-8580
Practice Address - Fax:313-372-7739
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010165981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice