Provider Demographics
NPI:1639811037
Name:ADDOUM, FADI
Entity Type:Individual
Prefix:
First Name:FADI
Middle Name:
Last Name:ADDOUM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 THOMPSON RD STE 2
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01570-1408
Mailing Address - Country:US
Mailing Address - Phone:508-943-8111
Mailing Address - Fax:
Practice Address - Street 1:50 THOMPSON RD STE 2
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:MA
Practice Address - Zip Code:01570-1408
Practice Address - Country:US
Practice Address - Phone:508-943-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-07
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1859384122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist