Provider Demographics
NPI:1609905694
Name:FAKOURY, TERESA C (DMD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:C
Last Name:FAKOURY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 REYNOLDS RD
Mailing Address - Street 2:
Mailing Address - City:BARNWELL
Mailing Address - State:SC
Mailing Address - Zip Code:29812-1521
Mailing Address - Country:US
Mailing Address - Phone:803-259-3497
Mailing Address - Fax:
Practice Address - Street 1:733 REYNOLDS RD
Practice Address - Street 2:
Practice Address - City:BARNWELL
Practice Address - State:SC
Practice Address - Zip Code:29812-1521
Practice Address - Country:US
Practice Address - Phone:803-259-3497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice