Provider Demographics
NPI:1548689532
Name:FAKHAR, CAMRON (DDS, MD)
Entity type:Individual
Prefix:DR
First Name:CAMRON
Middle Name:
Last Name:FAKHAR
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 OLD BRICK RD APT 4330
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-6003
Mailing Address - Country:US
Mailing Address - Phone:904-210-5472
Mailing Address - Fax:
Practice Address - Street 1:2425 OLD BRICK RD APT 4330
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-6003
Practice Address - Country:US
Practice Address - Phone:904-210-5472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-08
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014170691223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty