Provider Demographics
NPI:1578669537
Name:FANOUS, RAMSEY MATTHEW (DDS)
Entity Type:Individual
Prefix:
First Name:RAMSEY
Middle Name:MATTHEW
Last Name:FANOUS
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 1:400 N. ALLEN DRIVE
Mailing Address - Street 2:#207
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013
Mailing Address - Country:US
Mailing Address - Phone:972-359-8100
Mailing Address - Fax:972-359-8107
Practice Address - Street 1:400 N. ALLEN DRIVE
Practice Address - Street 2:#207
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013
Practice Address - Country:US
Practice Address - Phone:972-359-8100
Practice Address - Fax:972-359-8107
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX163431223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery