Provider Demographics
NPI:1487797361
Name:FARDO, DEAN JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:DEAN
Middle Name:JOSEPH
Last Name:FARDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3104 WATSONS BND
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-8826
Mailing Address - Country:US
Mailing Address - Phone:770-317-2193
Mailing Address - Fax:770-667-0206
Practice Address - Street 1:4165 OLD MILTON PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4468
Practice Address - Country:US
Practice Address - Phone:770-667-0904
Practice Address - Fax:770-667-0206
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049534208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery