Provider Demographics
NPI:1720676315
Name:FAKHRY, MARY MAHFOUZ
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MAHFOUZ
Last Name:FAKHRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2675 FIRESTONE DR
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-2735
Mailing Address - Country:US
Mailing Address - Phone:727-776-8572
Mailing Address - Fax:
Practice Address - Street 1:7801 9TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-1108
Practice Address - Country:US
Practice Address - Phone:727-525-4499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist