=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952929143
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FADY SADEK DMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2020
-----------------------------------------------------
Last Update Date | 10/29/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4660 VETERANS MEMORIAL DR # F1
-----------------------------------------------------
City | BATAVIA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14020-1298
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-344-7006
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 105 RALEIGH ST
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14620-4121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 438-830-0226
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 062175
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------