Fahad Al-Fadhli
Individual provider Active NPI General Practice Dentistry · Madison, MS
NPI 1669963518 · NPPES record last updated Sep 9, 2019
Key facts
- NPI
- 1669963518
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 4071-19 (MS)
- Practice address
- 109 Sycamore RDG
Madison, MS 39110-7333 - Phone
- (601) 954-4476
- NPI assigned
- May 27, 2018
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4071-19 | MS | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | MS | ||
| General Practice Dentistry | 1223G0001X | 4071-19 | MS | Yes |
Addresses
Primary practice location
109 Sycamore RDG
Madison, MS 39110-7333
Mailing address
109 Sycamore RDG
Madison, MS 39110-7333
Phone (601) 898-3885
Other providers in Madison, MS
- Clifford C Adams III
- Advanced Interventional Specialist PLLC
- Christy Ainsworth
- Connor Hays Ainsworth
- Heston Neal Ainsworth
- Anna Katherine Alderman
- Ghaith Aleithawe
- Ashley Alexander
- Kimberly Allen
- Allpharm Inc.
All providers in Madison, MS · General Practice Dentistry in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 9, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.