Provider Demographics
NPI:1013106350
Name:FADDOUL, FADY FOUAD (DDS,MSD)
Entity type:Individual
Prefix:DR
First Name:FADY
Middle Name:FOUAD
Last Name:FADDOUL
Suffix:
Gender:M
Credentials:DDS,MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 EL PASO DRIVE, MSC 24001
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905
Mailing Address - Country:US
Mailing Address - Phone:915-215-4579
Mailing Address - Fax:
Practice Address - Street 1:222 RICK FRANCIS ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2817
Practice Address - Country:US
Practice Address - Phone:915-215-6700
Practice Address - Fax:216-368-6310
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX370641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice