Provider Demographics
NPI:1285225995
Name:SHAABAN, FADY (DDS)
Entity type:Individual
Prefix:
First Name:FADY
Middle Name:
Last Name:SHAABAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4320 COMMONS DR W UNIT 1312
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-8646
Mailing Address - Country:US
Mailing Address - Phone:224-801-9108
Mailing Address - Fax:
Practice Address - Street 1:1900 S FERDON BLVD STE 170
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-8510
Practice Address - Country:US
Practice Address - Phone:850-331-3392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN25643122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist