MEDICARE: FADI FARAH DMD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1376365239
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FADI FARAH DMD PC

Provider Business Mailing Address
First Line	:	672 PLEASANT ST
Second Line	:
City	:	PAXTON
State	:	MA
Zip	:	01612-1306
Country	:	US
Telephone Number	:	508-791-6140
Fax Number	:

Provider Business Practice Location Address
First Line	:	672 PLEASANT ST
Second Line	:
City	:	PAXTON
State	:	MA
Zip	:	01612-1306
Country	:	US
Telephone Number	:	508-791-6140
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	FADI FARAH
Credential	:
Telephone Number	:	508-557-2400

Provider Enumeration Date	:	10/30/2024
Last Update Date	:	03/23/2025

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