Provider Demographics
NPI:1750810198
Name:JAVED, FAWAD (DDS, AEGD, PHD)
Entity type:Individual
Prefix:DR
First Name:FAWAD
Middle Name:
Last Name:JAVED
Suffix:
Gender:M
Credentials:DDS, AEGD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:564 E RIDGE RD STE 202
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-1228
Mailing Address - Country:US
Mailing Address - Phone:585-266-0506
Mailing Address - Fax:585-270-8191
Practice Address - Street 1:625 ELMWOOD AVENUE
Practice Address - Street 2:BOX 683
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620
Practice Address - Country:US
Practice Address - Phone:585-275-8315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0603491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice