Provider Demographics
NPI:1639289234
Name:METRI, FADI R (DMD)
Entity Type:Individual
Prefix:MR
First Name:FADI
Middle Name:R
Last Name:METRI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 COREY STREET
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-1923
Mailing Address - Country:US
Mailing Address - Phone:617-325-2244
Mailing Address - Fax:617-325-9299
Practice Address - Street 1:28 COREY STREET
Practice Address - Street 2:
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-1923
Practice Address - Country:US
Practice Address - Phone:617-325-2244
Practice Address - Fax:617-325-9299
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18145122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist