Healthcare Provider Details

I. General information

NPI: 1639097645
Provider Name (Legal Business Name): FAZIA BOUAKIZ DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 BYBERRY RD
BENSALEM PA
19020-3922
US

IV. Provider business mailing address

PO BOX 7274
PENNDEL PA
19047-7274
US

V. Phone/Fax

Practice location:
  • Phone: 215-638-3350
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS045649
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: