Fady Shaaban, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

DN25643 Issued in FL

Practice address

1900 S Ferdon Blvd Ste 170
Crestview, FL 32536-8510

Phone

(850) 331-3392

NPI assigned

Jan 27, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1611705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722211200000",
    "number": "1285225995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4320 COMMONS DR W UNIT 1312",
            "city": "DESTIN",
            "state": "FL",
            "postal_code": "325418646",
            "telephone_number": "224-801-9108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 S FERDON BLVD STE 170",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325368510",
            "telephone_number": "850-331-3392"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "208 Hospital Dr NE",
            "address_purpose": "LOCATION",
            "city": "Fort Walton Beach",
            "state": "FL",
            "postal_code": "325485068",
            "country_code": "US",
            "telephone_number": "850-518-3278",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAABAN",
        "first_name": "FADY",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-01-27",
        "last_updated": "2024-07-29",
        "certification_date": "2024-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN25643",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Seaside Spine Crestview LLC
• Mary Seidenfaden
• Sergio J Cabrera MD PL
• Donald Sexton, PA-C
• Jason G Seymour, D.M.D.
• Thomas J Shaknovsky, DO
• Joseph Shalit, MD
• Anna Layne Sharpe, LMHC
• Maria Shayhorn
• Stefanie A Shea, RN

• Dentist in Crestview, FL
• Providers in Crestview, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.