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Individual

DR. FADY SIDHOM

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DDS

Contact information

Practice address
567 SOUTHBRIDGE ST STE 7, AUBURN, MA 01501-2256
(508) 319-1480
Mailing address
1 CANAL ST UNIT 621, BOSTON, MA 02114-2054
(201) 937-0594

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
22DI02769200
NJ
122300000X
Dentist
Primary
DN1859394
MA
1223G0001X
General Practice Dentistry
22DI02769200
NJ
1223G0001X
General Practice Dentistry
DN1859394
MA

Other

Enumeration date
07/20/2019
Last updated
07/07/2022
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