Provider Demographics
NPI:1487677639
Name:FARES, FADI Y (DMD)
Entity type:Individual
Prefix:DR
First Name:FADI
Middle Name:Y
Last Name:FARES
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 1:12948 SERONERA VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34610-7667
Mailing Address - Country:US
Mailing Address - Phone:813-690-1736
Mailing Address - Fax:
Practice Address - Street 1:5139 LITTLE RD
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655-1212
Practice Address - Country:US
Practice Address - Phone:727-376-7338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN150841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice