Provider Demographics
NPI:1861147522
Name:MATTI, FADI NABEEL-GEORGES
Entity type:Individual
Prefix:
First Name:FADI
Middle Name:NABEEL-GEORGES
Last Name:MATTI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36177 WALTHAM DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-4504
Mailing Address - Country:US
Mailing Address - Phone:248-828-6031
Mailing Address - Fax:
Practice Address - Street 1:36177 WALTHAM DR
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-4504
Practice Address - Country:US
Practice Address - Phone:248-828-6031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-21
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107318122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist