Provider Demographics
NPI:1669958674
Name:ELAYYAN, FADI A (DMD)
Entity type:Individual
Prefix:DR
First Name:FADI
Middle Name:A
Last Name:ELAYYAN
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2824 PRAIRIE VIEW RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-8678
Mailing Address - Country:US
Mailing Address - Phone:708-415-4126
Mailing Address - Fax:
Practice Address - Street 1:4860 WASHTENAW AVE STE D
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-3401
Practice Address - Country:US
Practice Address - Phone:734-999-9909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016012501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2901601250OtherDENTAL LICENSE