Healthcare Provider Details

I. General information

NPI: 1699536672
Provider Name (Legal Business Name): FAI ALKHNFOOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2024
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVE
CLEVELAND OH
44106-1716
US

IV. Provider business mailing address

12303 CEDAR RD # 2-414
CLEVELAND OH
44106-3174
US

V. Phone/Fax

Practice location:
  • Phone: 312-978-9664
  • Fax:
Mailing address:
  • Phone: 312-978-9664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number00206557
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: