Provider Demographics
NPI:1265544811
Name:ZAKNOUN, FADI (DMD)
Entity type:Individual
Prefix:DR
First Name:FADI
Middle Name:
Last Name:ZAKNOUN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 CHURCH AVE
Mailing Address - Street 2:SUITE #101
Mailing Address - City:WAREHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02571-2093
Mailing Address - Country:US
Mailing Address - Phone:508-295-3388
Mailing Address - Fax:508-295-3289
Practice Address - Street 1:40 CHURCH AVE
Practice Address - Street 2:SUITE #101
Practice Address - City:WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02571-2093
Practice Address - Country:US
Practice Address - Phone:508-295-3388
Practice Address - Fax:508-295-3289
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA192971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice