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General NPI Number Information
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NPI Number | 1487797361
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Entity Type | Individual
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Provider Name | DEAN JOSEPH FARDO M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 09/30/2010
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Provider Practice Location Address
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Address Line | 4165 OLD MILTON PKWY SUITE 200
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City | ALPHARETTA
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State | GA
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Zip | 30005-4468
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Country | US
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Telephone | 770-667-0904
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Fax | 770-667-0206
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Provider Business Mailing Address
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Address Line | 3104 WATSONS BND
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City | ALPHARETTA
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State | GA
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Zip | 30004-8826
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Country | US
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Telephone | 770-317-2193
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Fax | 770-667-0206
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 049534
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License Number State | GA
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