Provider Demographics
NPI:1689805145
Name:FAKHOURI, IYAD JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:IYAD
Middle Name:JAMES
Last Name:FAKHOURI
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 1:1880 ARLINGTON ST
Mailing Address - Street 2:SUITE #205
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-3524
Mailing Address - Country:US
Mailing Address - Phone:941-953-4288
Mailing Address - Fax:941-953-2728
Practice Address - Street 1:7442 N TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-1800
Practice Address - Country:US
Practice Address - Phone:941-351-8338
Practice Address - Fax:941-355-8853
Is Sole Proprietor?:No
Enumeration Date:2009-08-01
Last Update Date:2009-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN16329122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist