Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DN26284 | FL |
Y | 1223D0001X | Dental Public Health | 30.026643 | OH |
NPI | 1194491514 |
---|---|
Provider Name | Fadi Khaled Aeadah Mdanat |
First Address | Westlake, OH 44145-8178 |
Second Address | Sandusky, OH 44870-4736 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2021 |
Last Update Date | 14/12/2021 |