Provider Demographics
NPI:1942332309
Name:FAKHOURY, NICOLAS WADIH (DMD PA)
Entity Type:Individual
Prefix:DR
First Name:NICOLAS
Middle Name:WADIH
Last Name:FAKHOURY
Suffix:
Gender:M
Credentials:DMD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 LINTON BLVD
Mailing Address - Street 2:STE C5
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33444
Mailing Address - Country:US
Mailing Address - Phone:561-278-4475
Mailing Address - Fax:561-278-3484
Practice Address - Street 1:1100 LINTON BLVD
Practice Address - Street 2:STE C5
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33444
Practice Address - Country:US
Practice Address - Phone:561-278-4475
Practice Address - Fax:561-278-3484
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00142911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice