Provider Demographics
NPI:1265617617
Name:FAHEY, DANA A (DMD)
Entity type:Individual
Prefix:MRS
First Name:DANA
Middle Name:A
Last Name:FAHEY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 NE 26TH AVENUE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304
Mailing Address - Country:US
Mailing Address - Phone:954-566-4208
Mailing Address - Fax:954-566-5346
Practice Address - Street 1:900 NE 26TH AVENUE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304
Practice Address - Country:US
Practice Address - Phone:954-566-4208
Practice Address - Fax:954-566-5346
Is Sole Proprietor?:No
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12687122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist