Provider Demographics
NPI:1265514418
Name:FAKHOURY, FADY I (DDS)
Entity type:Individual
Prefix:DR
First Name:FADY
Middle Name:I
Last Name:FAKHOURY
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 1:10911 BONITA BEACH RD SE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-9053
Mailing Address - Country:US
Mailing Address - Phone:239-495-9900
Mailing Address - Fax:239-495-6256
Practice Address - Street 1:10911 BONITA BEACH RD SE
Practice Address - Street 2:SUITE 105
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-9053
Practice Address - Country:US
Practice Address - Phone:239-495-9900
Practice Address - Fax:239-495-6256
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN161601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice