Provider Demographics
NPI:1518755040
Name:FARDOUS DENTAL SERVICES
Entity type:Organization
Organization Name:FARDOUS DENTAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SAHAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:FARDOUS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:313-414-6109
Mailing Address - Street 1:3757 OAKRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9392
Mailing Address - Country:US
Mailing Address - Phone:313-414-6109
Mailing Address - Fax:
Practice Address - Street 1:24510 FORD RD
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-3110
Practice Address - Country:US
Practice Address - Phone:313-561-2100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty