Healthcare Provider Details

I. General information

NPI: 1396356275
Provider Name (Legal Business Name): FAHRA Y DAWOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2020
Last Update Date: 08/13/2020
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 S UNIVERSITY DR
DAVIE FL
33328-2018
US

IV. Provider business mailing address

3015 W SIGNATURE DR APT 307
DAVIE FL
33314-6458
US

V. Phone/Fax

Practice location:
  • Phone: 954-262-1782
  • Fax:
Mailing address:
  • Phone: 718-877-5348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDRP2236
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: