Provider Demographics
NPI:1598774853
Name:FEHMI, NABIL (DDS)
Entity Type:Individual
Prefix:
First Name:NABIL
Middle Name:
Last Name:FEHMI
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 1:3019 N 35TH AVE
Mailing Address - Street 2:109
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85017-5206
Mailing Address - Country:US
Mailing Address - Phone:602-269-7797
Mailing Address - Fax:602-269-2329
Practice Address - Street 1:3019 N 35TH AVE
Practice Address - Street 2:109
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85017-5206
Practice Address - Country:US
Practice Address - Phone:602-269-7797
Practice Address - Fax:602-269-2329
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2008-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ65431223G0001X
MI29010177551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ074462Medicaid
MI020635027OtherTAX IDENTIFICATION NUMBER
AZ074462Medicaid