Provider Demographics
NPI:1588788756
Name:TEIXEIRA, FABRICIO (DDS, MS, PHD)
Entity type:Individual
Prefix:DR
First Name:FABRICIO
Middle Name:
Last Name:TEIXEIRA
Suffix:
Gender:M
Credentials:DDS, MS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 BUSINESS SCIENCE BLDG S
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1001
Mailing Address - Country:US
Mailing Address - Phone:319-335-7440
Mailing Address - Fax:
Practice Address - Street 1:341 DENTAL SCIENCE BLDG S
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1001
Practice Address - Country:US
Practice Address - Phone:319-335-7469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA401521223E0200X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics